Organization Name: | OUTLOOK OUTPATIENT SERVICES, LLC |
NPI Number: | 1225448517 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JASON VAUGHAN DAVID (PROGRAM DIRECTOR) |
Mailing Address: | 21030 Point Lookout Rd #10 Callaway |
State: | MD US |
Postal Code: | 206202339 |
Phone Number: | 3014012047 |
Fax Number: | |
NPI Enumeration Date: | 05/07/2014 |
NPI Last Update Date: | 05/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |