Provider Demographics
NPI:1891934386
Name:POSITIVE OUTLOOKS
Entity Type:Organization
Organization Name:POSITIVE OUTLOOKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-546-3587
Mailing Address - Street 1:6105 MAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-3328
Mailing Address - Country:US
Mailing Address - Phone:406-546-3587
Mailing Address - Fax:406-543-2326
Practice Address - Street 1:6105 MAINVIEW DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-3328
Practice Address - Country:US
Practice Address - Phone:406-546-3587
Practice Address - Fax:406-543-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0177242Medicaid