Provider Demographics
NPI:1487968806
Name:PARKVIEW OUTREACH COMMUNITY CENTER
Entity type:Organization
Organization Name:PARKVIEW OUTREACH COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:ROOSEVELT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:EDD
Authorized Official - Phone:863-353-6853
Mailing Address - Street 1:1205 DR MARTIN L KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-3490
Mailing Address - Country:US
Mailing Address - Phone:863-353-6853
Mailing Address - Fax:863-438-2752
Practice Address - Street 1:1205 DR MARTIN L KING JR WAY
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3490
Practice Address - Country:US
Practice Address - Phone:863-353-6853
Practice Address - Fax:863-438-2752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable