Provider Demographics
NPI:1235679143
Name:NEW OUTLOOK
Entity Type:Organization
Organization Name:NEW OUTLOOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-554-3661
Mailing Address - Street 1:3051 LOWRY CT SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-5330
Mailing Address - Country:US
Mailing Address - Phone:616-554-3661
Mailing Address - Fax:
Practice Address - Street 1:3051 LOWRY CT SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-5330
Practice Address - Country:US
Practice Address - Phone:616-554-3661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF410285580311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home