# OUTREACH COMMUNITY CARE NETWORK

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962794917
- **Authorized official:** LORETTA JENNINGS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (386) 255-5569

## Contact information

- **Practice address:** 240 N FREDERICK AVE, DAYTONA BEACH, FL 32114-3400
- **Practice address phone:** (386) 255-5569
- **Mailing address:** 240 N FREDERICK AVE, DAYTONA BEACH, FL 32114-3400
- **Mailing address phone:** (386) 255-5569

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | 171M00000X | FL | Yes |

## Other

- **Enumeration date:** 05/10/2011
- **Last updated:** 05/10/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 800134861878011410N2 | — | FL |