NPIMap

Organization Active NPI

Outreach Community Care Network

  • Case Management Agency
  • Daytona Beach, FL
National Provider Identifier
1962794917
Registry record updated May 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
171M00000X Issued in FL
Legal business name
OUTREACH COMMUNITY CARE NETWORK
Practice address
240 N Frederick Ave
Daytona Beach, FL 32114-3400
Phone
(386) 255-5569
NPI assigned
May 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Loretta Jennings
Title
Executive Director
Phone
(386) 255-5569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 171M00000X FL Primary

Addresses

Primary practice location

240 N Frederick Ave
Daytona Beach, FL 32114-3400

Mailing address

240 N Frederick Ave
Daytona Beach, FL 32114-3400
Phone (386) 255-5569

Other identifiers 1

IdentifierTypeStateIssuer
800134861878011410N2MedicaidFL

National Provider Directory

National Provider Directory

Locations

240 N Frederick Ave
Daytona Beach, FL 32114
Phone (386) 255-5569

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304985600000",
    "number": "1962794917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 N FREDERICK AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321143400",
            "telephone_number": "386-255-5569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 N FREDERICK AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321143400",
            "telephone_number": "386-255-5569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH COMMUNITY CARE NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-10",
        "last_updated": "2011-05-10",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "386-255-5569"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "FL",
            "license": "171M00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800134861878011410N2",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.