Provider Demographics
NPI:1114614526
Name:OUTREACH RECOVERY II
Entity Type:Organization
Organization Name:OUTREACH RECOVERY II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ISIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-502-3978
Mailing Address - Street 1:14205 PARK PARK CENTER DR.
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:410-800-4466
Mailing Address - Fax:
Practice Address - Street 1:21552 THAMES AVE STE 201202
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-4009
Practice Address - Country:US
Practice Address - Phone:410-800-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTREACH RECOVERY II
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)