Provider Demographics
NPI:1225900277
Name:OUTLOOK RESIDENTIAL
Entity type:Organization
Organization Name:OUTLOOK RESIDENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAYISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONKIYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-479-7609
Mailing Address - Street 1:3252 SE OLSEN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5733
Mailing Address - Country:US
Mailing Address - Phone:425-479-7609
Mailing Address - Fax:
Practice Address - Street 1:3252 SE OLSEN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-5733
Practice Address - Country:US
Practice Address - Phone:425-524-2492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health