Provider Demographics
NPI:1063767010
Name:OUTREACH YOUTH & FAMILY SERVICES
Entity type:Organization
Organization Name:OUTREACH YOUTH & FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-840-4497
Mailing Address - Street 1:9443 S THROOP ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3625
Mailing Address - Country:US
Mailing Address - Phone:773-840-4497
Mailing Address - Fax:773-905-1369
Practice Address - Street 1:9443 S THROOP ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3625
Practice Address - Country:US
Practice Address - Phone:773-840-4497
Practice Address - Fax:773-905-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL305R00000X, 385HR2055X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child