Provider Demographics
NPI:1841469954
Name:CLINICAL OUTCOMES GROUP, INC.
Entity type:Organization
Organization Name:CLINICAL OUTCOMES GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEISCHUT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:570-628-6990
Mailing Address - Street 1:1 S 2ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3088
Mailing Address - Country:US
Mailing Address - Phone:570-628-6990
Mailing Address - Fax:570-628-5899
Practice Address - Street 1:1 S 2ND ST FL 1
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3088
Practice Address - Country:US
Practice Address - Phone:570-628-6990
Practice Address - Fax:570-628-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125918104100000X
PAPC000151291U00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101365368Medicaid