Organization
OUTREACH RECOVERY II, LLC
Active
Organization
OUTREACH RECOVERY II, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISIAH COLES (COO)
(561) 502-3978
Entity
Organization
Contact information
Practice address
11340 PEMBROOKE SQ STE 214, WALDORF, MD 20603-4808
(410) 800-4466
Mailing address
14205 PARK CENTER DR # 201202, LAUREL, MD 20707-5246
(410) 800-4466
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
—
—
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
777797300
—
MD
Enumeration date
05/10/2019
Last updated
07/31/2024
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