Organization
OUTREACH COMMUNITY CARE NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORETTA JENNINGS (EXECUTIVE DIRECTOR)
(386) 255-5569
Entity
Organization
Contact information
Practice address
240 N FREDERICK AVE, DAYTONA BEACH, FL 32114-3400
(386) 255-5569
Mailing address
240 N FREDERICK AVE, DAYTONA BEACH, FL 32114-3400
(386) 255-5569
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
171M00000X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
800134861878011410N2
—
FL
Enumeration date
05/10/2011
Last updated
05/10/2011
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