Provider Demographics
NPI:1538589270
Name:GINA OUTREACH, INC
Entity type:Organization
Organization Name:GINA OUTREACH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:BEBNJI
Authorized Official - Last Name:NDONGBOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-463-2324
Mailing Address - Street 1:5032 10TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2844
Mailing Address - Country:US
Mailing Address - Phone:240-463-2324
Mailing Address - Fax:202-747-3877
Practice Address - Street 1:5032 10TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2844
Practice Address - Country:US
Practice Address - Phone:240-463-2324
Practice Address - Fax:202-747-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCEIN800320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities