Provider Demographics
NPI:1124762331
Name:OUTREACH DELIVERANCE CENTER, INC
Entity type:Organization
Organization Name:OUTREACH DELIVERANCE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-402-2210
Mailing Address - Street 1:253 MAGNOLIA PARK TRL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7215
Mailing Address - Country:US
Mailing Address - Phone:407-402-2210
Mailing Address - Fax:
Practice Address - Street 1:253 MAGNOLIA PARK TRL
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7215
Practice Address - Country:US
Practice Address - Phone:407-402-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable