Provider Demographics
NPI:1467963124
Name:QUALITY OUTLOOK
Entity Type:Organization
Organization Name:QUALITY OUTLOOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:602-461-5330
Mailing Address - Street 1:1717 W GLENDALE AVE APT 3011
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8817
Mailing Address - Country:US
Mailing Address - Phone:602-461-5330
Mailing Address - Fax:
Practice Address - Street 1:1717 W GLENDALE AVE APT 3011
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8817
Practice Address - Country:US
Practice Address - Phone:602-461-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP046141164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1568980779Medicaid