| Supportive Outreach Services Llc | |
|
25925 Telegraph Rd Ste 103 Southfield MI 48033-2527 | |
| (313) 405-8064 | |
| (313) 429-7649 |
| Full Name | Supportive Outreach Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 25925 Telegraph Rd Ste 103, Southfield, Michigan |
| Authorized Official Name and Position | Tacara L Woods (OWNER/SOCIAL WORKER) |
| Authorized Official Contact | 3133085510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supportive Outreach Services Llc Po Box 753 Eastpointe MI 48021-0753 Ph: (313) 405-8064 | Supportive Outreach Services Llc 25925 Telegraph Rd Ste 103 Southfield MI 48033-2527 Ph: (313) 405-8064 |
| NPI Number | 1144627027 |
|---|---|
| Provider Enumeration Date | 11/20/2014 |
| Last Update Date | 02/13/2019 |
| Medicare PECOS PAC ID | 8729327416 |
|---|---|
| Medicare Enrollment ID | O20190225000072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144627027 | NPI | - | NPPES |
| Provider Name | Tacara L Woods |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770071201 PECOS PAC ID: 1355693995 Enrollment ID: I20181010001785 |
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