Provider Demographics
NPI:1477951093
Name:OUTBACK CARE GROUP
Entity Type:Organization
Organization Name:OUTBACK CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-887-5077
Mailing Address - Street 1:325 LEE ROAD 791
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AL
Mailing Address - Zip Code:36874-1443
Mailing Address - Country:US
Mailing Address - Phone:706-594-4266
Mailing Address - Fax:334-363-0864
Practice Address - Street 1:6836 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-4707
Practice Address - Country:US
Practice Address - Phone:762-821-2861
Practice Address - Fax:334-363-0864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTBACK TECHNOLOGIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-13
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH008458310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility