Outward Bound One, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

OUTWARD BOUND ONE, LLC

Practice address

620 Guilford College Rd
Ste G
Greensboro, NC 27409-2292

Phone

(336) 553-9898

Fax

(336) 447-1955

NPI assigned

Oct 28, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Trishonda Patrick

Title

Executive Director

Phone

(336) 553-9898

Specialties & licenses 3

Addresses

Other names 1

• Outward Bound Community Services Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466121600000",
    "number": "1164675815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 GUILFORD COLLEGE RD",
            "address_2": "STE G",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274092292",
            "telephone_number": "336-553-9898",
            "fax_number": "336-447-1955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 GUILFORD COLLEGE RD",
            "address_2": "STE G",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274092292",
            "telephone_number": "336-553-9898",
            "fax_number": "336-447-1955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTWARD BOUND ONE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2016-06-17",
        "status": "A",
        "authorized_official_last_name": "PATRICK",
        "authorized_official_first_name": "TRISHONDA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-553-9898"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Outward Bound Community Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Terri Lynn Otto X, NP
• Richard George Ouellette, CRNA
• Jessica Moser Oughton, MSW, LCSW
• Brandon Earl Outlaw, MSW, LCSWA
• William Marcus Outlaw, MD
• Carley Overman, OTR/L
• Amanda Joan Overocker, LPC, NCC
• Joan Overstreet
• Sherri Dawn Overstreet, M.ED., CCC-SLP
• Jackson Lonnie Overturf, PA-C

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.