Organization
ULTIMATE OUTCOMES THERAPEUTIC SERVICES
Active
Other names
Ultimate Outcomes Therapuetic Services
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE BAZEMORE (ADMINISTRATOR)
(804) 213-0140
Entity
Organization
Contact information
Practice address
4901 FITZHUGH AVE STE 200, RICHMOND, VA 23230-3531
(804) 213-0140
(804) 213-0140
Mailing address
PO BOX 6386, RICHMOND, VA 23230-0386
(804) 213-0140
(804) 213-0143
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
46403001
VA
251S00000X
Community/Behavioral Health Agency
46405001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801124607
—
VA
Enumeration date
12/07/2009
Last updated
05/02/2019
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