Provider Demographics
NPI:1922716646
Name:CONNECTED OUTPATIENT INC.
Entity Type:Organization
Organization Name:CONNECTED OUTPATIENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEVAN
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:CHIMAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-414-0525
Mailing Address - Street 1:14242 VENTURA BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2757
Mailing Address - Country:US
Mailing Address - Phone:747-217-4033
Mailing Address - Fax:747-217-4380
Practice Address - Street 1:14242 VENTURA BLVD STE 211
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2757
Practice Address - Country:US
Practice Address - Phone:747-217-4033
Practice Address - Fax:747-217-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder