Organization
OUTREACH RECOVERY II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISIAH COLES (COO)
(561) 502-3978
Entity
Organization
Contact information
Practice address
1831 FOREST DR STE E, ANNAPOLIS, MD 21401-4430
(410) 800-4466
Mailing address
4201 NORTHVIEW DR STE 104, BOWIE, MD 20716-2604
(410) 800-4466
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
777797300
—
MD
Enumeration date
05/10/2019
Last updated
03/05/2021
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