Provider Demographics
NPI:1518227370
Name:OUTWARD BOUND
Entity Type:Organization
Organization Name:OUTWARD BOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRISHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-558-6171
Mailing Address - Street 1:6130 ELTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2538
Mailing Address - Country:US
Mailing Address - Phone:336-697-9310
Mailing Address - Fax:336-510-0928
Practice Address - Street 1:6130 ELTON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2538
Practice Address - Country:US
Practice Address - Phone:336-697-9310
Practice Address - Fax:336-510-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management