Organization
OUTREACH HOME # 3.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOY N. OKEKE RN (ADMINISTRATOR)
(919) 641-0162
Entity
Organization
Contact information
Practice address
1717 N ALSTON AVE, DURHAM, NC 27701-2301
(919) 683-2707
Mailing address
305 SHALIMAR DR, DURHAM, NC 27713-7571
(919) 683-2707
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-032-355
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805420
—
NC
Enumeration date
04/17/2007
Last updated
06/16/2008
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