Provider Demographics
NPI:1427918556
Name:FRESH OUTLOOK SUPPORT LLC
Entity type:Organization
Organization Name:FRESH OUTLOOK SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SATTA
Authorized Official - Middle Name:YONDAY
Authorized Official - Last Name:SAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:301-806-7580
Mailing Address - Street 1:13810 FRANKS RUN RD
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-1265
Mailing Address - Country:US
Mailing Address - Phone:301-806-7580
Mailing Address - Fax:
Practice Address - Street 1:13810 FRANKS RUN RD
Practice Address - Street 2:
Practice Address - City:SMITHSBURG
Practice Address - State:MD
Practice Address - Zip Code:21783-1265
Practice Address - Country:US
Practice Address - Phone:301-806-7580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility