OUTREACH HOME #1 (NPI# 1063638328) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063638328 |
| Entity Type | Organization |
| Organization Name | OUTREACH HOME #1 |
| Practice Address |
2826 S Roxboro St Durham NC 27707-4039 |
| Mailing Address |
305 Shalimar Dr Durham NC 27713-7571 |
| Practice Telephone | 9194018352 |
| Mailing Telephone | 9195441033 |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. JOY N. OKEKE (ADMINISTRATOR) |
| Authorized Official Telephone | 9196410162 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | MHL032299 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7804843 | 05 |
| Street Address |
2826 S ROXBORO ST |
| City | DURHAM |
| State | NC |
| Zip Code | 27707-4039 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538785928 | Ceara Smith | Social Worker | 1415 W Nc 54 Buidling 200, Suite 111, Durham, NC 27707 | 2020-06-22 |
| 1114554094 | Lauren Michelle Grosse | Physician Assistant | Fastmed Urgent Care 7010 Nc-751, Durham, NC 27707 | 2020-03-23 |
| 1386289635 | Ashley Bailey | Counselor | 1801 Fayetteville Street, Durham, NC 27707 | 2019-11-11 |
| 1881249886 | Erin Ramona Leger | Physical Therapist | 3706 Mayfair St, Ste 120, Durham, NC 27707 | 2019-08-06 |
| 1417417262 | Carmen Elisabeth Sanchez | Psychologist | 3326 Durham Chapel Hill Blvd Bldg D, Durham, NC 27707 | 2019-03-20 |
| 1477026144 | Pope Behavioral Health and Wellness | Counselor | 5102 Chapel Hill Durham Blvd., Suite 101, Durham, NC 27707 | 2019-01-06 |
| 1043780778 | Jessica Ann Revels | Counselor | 1415 West North Carolina 54, Building 100 Suite # 204, Durham, NC 27707 | 2018-11-26 |
| 1558830125 | Michael Brown | Counselor | 1502 W Nc-54, Suite 505, Durham, NC 27707 | 2018-11-13 |
| 1780152827 | Cassandra Gerwig Shaw | Registered Nurse | 5324 Mcfarland Dr Ste 310, Durham, NC 27707 | 2018-11-07 |
| 1942776232 | Lisa J Keskitalo | Physical Therapist | 3708 Mayfair St Ste 120, Durham, NC 27707 | 2018-10-15 |
| Find all providers in zip 27707 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417329749 | Troy Leigh Lockamy | Residential Treatment Facility, Physical Disabilities | 300 Meredith Dr, Durham, NC 27713-2282 | 2015-10-26 |
| 1982061610 | Changing Places Family Care Home of Durham, LLC | Residential Treatment Facility, Physical Disabilities | 725 Hanson Rd, Durham, NC 27713-1117 | 2016-01-26 |
| 1649699588 | Jamaal Leathers | Residential Treatment Facility, Physical Disabilities | 1011 Park Ave, Durham, NC 27701-3548 | 2014-04-08 |
| 1760723514 | Changing Places Family Care Home | Residential Treatment Facility, Physical Disabilities | 725 Hanson Rd, Durham, NC 27713-1117 | 2013-03-04 |
| 1811254972 | Changing Places | Residential Treatment Facility, Physical Disabilities | 725 Hanson Rd, Durham, NC 27713-1117 | 2012-04-13 |
| 1619115078 | Duke Diet and Fitness Center | Residential Treatment Facility, Physical Disabilities | 501 Douglas St, Durham, NC 27705-3888 | 2009-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346883170 | Vision of Therapeutic Development, Inc. | Residential Treatment Facility, Physical Disabilities | 35 Southern Village Dr, Roxboro, NC 27573-2516 | 2019-10-24 |
| 1144760844 | Tjt Family Home | Residential Treatment Facility, Physical Disabilities | 116 Leanne Dr, Greenville, NC 27858-8126 | 2017-02-28 |
| 1104361518 | Senior Care Carolinas | Residential Treatment Facility, Physical Disabilities | 9640 Gilead Grove Rd, Huntersville, NC 28078-2289 | 2016-12-21 |
| 1780049429 | Pta | Residential Treatment Facility, Physical Disabilities | 1900 Sheldon Road, Greensboro, NC 27405 | 2015-12-23 |
| 1689044638 | April Campbell Lee | Residential Treatment Facility, Physical Disabilities | 3204 Huntleigh Dr, Raleigh, NC 27604-3310 | 2015-10-03 |
| 1538545025 | Viktoriya Semenova | Residential Treatment Facility, Physical Disabilities | 1405 Falls Church Rd, Raleigh, NC 27609-4015 | 2015-08-06 |
| 1356744932 | Z & M Residential Villa 1 | Residential Treatment Facility, Physical Disabilities | 10298 Pasture Rd, Middlesex, NC 27557-7200 | 2014-09-26 |
| 1841608866 | Noa Human Services LLC 3 | Residential Treatment Facility, Physical Disabilities | 1847 Waycross Drive, Winston Salem, NC 27106 | 2014-07-23 |
| 1831527233 | Audrey F Jessup | Residential Treatment Facility, Physical Disabilities | 1471 Deer Rd, Mt Airy, NC 27030-1471 | 2013-10-22 |
| 1194150417 | Azalea Garden | Residential Treatment Facility, Physical Disabilities | 413 Culvert St, Apex, NC 27502-1731 | 2013-09-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.