Provider Demographics
NPI:1992867543
Name:OUTLOOK THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:OUTLOOK THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARABET
Authorized Official - Middle Name:
Authorized Official - Last Name:HZOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-440-0991
Mailing Address - Street 1:2560 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3406
Mailing Address - Country:US
Mailing Address - Phone:626-440-0991
Mailing Address - Fax:626-405-0311
Practice Address - Street 1:2560 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3406
Practice Address - Country:US
Practice Address - Phone:626-440-0991
Practice Address - Fax:626-405-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA054545Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER