Provider Demographics
NPI:1851038095
Name:MAKING MOVEZ INITIATIVE OUTREACH
Entity type:Organization
Organization Name:MAKING MOVEZ INITIATIVE OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BS, AND AS
Authorized Official - Phone:937-516-1130
Mailing Address - Street 1:24 REDDER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2222
Mailing Address - Country:US
Mailing Address - Phone:937-516-1130
Mailing Address - Fax:
Practice Address - Street 1:24 REDDER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2222
Practice Address - Country:US
Practice Address - Phone:937-516-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable