1427270081 NPI number — HEALTHY OUTLOOK MANAGEMENT ENTERPRISES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427270081 NPI number — HEALTHY OUTLOOK MANAGEMENT ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY OUTLOOK MANAGEMENT ENTERPRISES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AIRBASE ROAD CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427270081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2380 AIRBASE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRY PRONG
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-466-1411
Provider Business Mailing Address Fax Number:
318-466-1409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2380 AIRBASE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRY PRONG
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-466-1411
Provider Business Practice Location Address Fax Number:
318-466-1409
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSIER
Authorized Official First Name:
RONDA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATION
Authorized Official Telephone Number:
318-466-1411

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP3327 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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