Provider Demographics
NPI:1154783793
Name:GREATER OUTREACH SERVICES
Entity type:Organization
Organization Name:GREATER OUTREACH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NYESHA
Authorized Official - Middle Name:SHANTA
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-672-2407
Mailing Address - Street 1:2530 MERIDIAN PKWY STE 3012
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5272
Mailing Address - Country:US
Mailing Address - Phone:833-741-7770
Mailing Address - Fax:866-770-5166
Practice Address - Street 1:1109 BROAD ST STE G
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3623
Practice Address - Country:US
Practice Address - Phone:833-741-7770
Practice Address - Fax:866-770-5166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER OUTREACH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-23
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health