Provider Demographics
NPI:1861937971
Name:CONTROLLED OUTCOMES
Entity type:Organization
Organization Name:CONTROLLED OUTCOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-415-8106
Mailing Address - Street 1:3714 RUFFIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23860-8629
Mailing Address - Country:US
Mailing Address - Phone:804-415-8106
Mailing Address - Fax:804-415-8106
Practice Address - Street 1:3714 RUFFIN RD
Practice Address - Street 2:
Practice Address - City:NORTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23860-8629
Practice Address - Country:US
Practice Address - Phone:804-415-8106
Practice Address - Fax:804-415-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable