Healthcare Provider Details

I. General information

NPI: 1932509429
Provider Name (Legal Business Name): OUTSIDE IN SCHOOL OF EXPERIENTIAL EDUCATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 10/08/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W BEAU ST SUITE 114
WASHINGTON PA
15301-4425
US

IV. Provider business mailing address

196 HAMILL SCHOOL RD
BOLIVAR PA
15923-2525
US

V. Phone/Fax

Practice location:
  • Phone: 724-837-1518
  • Fax: 724-837-0801
Mailing address:
  • Phone: 724-238-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number637040
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ADRIEN CAMERON
Title or Position: FINANCIAL TECHNICIAN MANAGER
Credential:
Phone: 724-238-8441