Provider Demographics
NPI:1073746202
Name:ABSOLUTE OUTCOMES, LLC
Entity Type:Organization
Organization Name:ABSOLUTE OUTCOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-880-5335
Mailing Address - Street 1:PO BOX 4058
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-4058
Mailing Address - Country:US
Mailing Address - Phone:203-880-5335
Mailing Address - Fax:203-643-2000
Practice Address - Street 1:324 ELM ST
Practice Address - Street 2:SUITE 202B
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2280
Practice Address - Country:US
Practice Address - Phone:203-880-5335
Practice Address - Fax:203-907-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1073746202Medicaid
CT1073746202Medicaid