Outward Bound One LLC
Community/Behavioral Health in Conyers, GA. Organization (NPI-2).
NPI number1699178673
StatusActive
Last updated in NPPESOct 3, 2014
Details
- NPI
- 1699178673
- Entity type
- Organization (NPI-2)
- Legal business name
- Outward Bound One LLC
- Organization subpart
- No
- Enumeration date
- Oct 3, 2014
- Last updated
- Oct 3, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
2141 Smyrna Rd SwConyers, GA 30094-6168
Phone 336-382-9618
Mailing address
2141 Smyrna Rd SwConyers, GA 30094-6168
Authorized official
Derrick McDow
Ceo/Owner
3363829618
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