Provider Demographics
NPI:1295856185
Name:OUTSIDE IN SCHOOL OF EXPERIENTIAL EDUCATION, INC.
Entity Type:Organization
Organization Name:OUTSIDE IN SCHOOL OF EXPERIENTIAL EDUCATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL TECHNICIAN MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-238-8441
Mailing Address - Street 1:196 HAMILL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:PA
Mailing Address - Zip Code:15923-2525
Mailing Address - Country:US
Mailing Address - Phone:724-238-8441
Mailing Address - Fax:
Practice Address - Street 1:580 FEIGHTNER ROAD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6453
Practice Address - Country:US
Practice Address - Phone:724-837-1518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA657043251K00000X, 324500000X
251S00000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children