Provider Demographics
NPI:1952798688
Name:JCTOD OUTREACH, INC
Entity Type:Organization
Organization Name:JCTOD OUTREACH, INC
Other - Org Name:JOHNSON PARK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCATES
Authorized Official - Suffix:
Authorized Official - Credentials:DD
Authorized Official - Phone:315-734-9608
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13503-0160
Mailing Address - Country:US
Mailing Address - Phone:315-734-9608
Mailing Address - Fax:315-266-1223
Practice Address - Street 1:26 JOHNSON PARK
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13503-0160
Practice Address - Country:US
Practice Address - Phone:315-734-9608
Practice Address - Fax:315-266-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle