Provider Demographics
NPI:1699133827
Name:MARTIN LUTHER KING JR FAMILY OUTREACH CENTER
Entity type:Organization
Organization Name:MARTIN LUTHER KING JR FAMILY OUTREACH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-455-8722
Mailing Address - Street 1:845 S SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1260
Mailing Address - Country:US
Mailing Address - Phone:509-455-8722
Mailing Address - Fax:509-455-7801
Practice Address - Street 1:845 S SHERMAN ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1260
Practice Address - Country:US
Practice Address - Phone:509-455-8722
Practice Address - Fax:509-455-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable