Healthcare Provider Details

I. General information

NPI: 1063585529
Provider Name (Legal Business Name): OUTLOOK HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6413 OAK ST
NORTH BRANCH MN
55056-5129
US

IV. Provider business mailing address

PO BOX 320
NORTH BRANCH MN
55056-0320
US

V. Phone/Fax

Practice location:
  • Phone: 651-674-4570
  • Fax: 651-674-8740
Mailing address:
  • Phone: 651-674-4570
  • Fax: 651-674-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: BETTY NELSON
Title or Position: DIRECTOR
Credential:
Phone: 651-674-4570