Provider Demographics
NPI:1215557038
Name:KOLMAC CLINIC LLC
Entity Type:Organization
Organization Name:KOLMAC CLINIC LLC
Other - Org Name:KOLMAC OUTPATIENT RECOVERY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP RCM
Authorized Official - Prefix:
Authorized Official - First Name:KEONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-239-3309
Mailing Address - Street 1:3905 NATIONAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-6143
Mailing Address - Country:US
Mailing Address - Phone:667-239-3309
Mailing Address - Fax:
Practice Address - Street 1:3905 NATIONAL DR STE 200
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-6143
Practice Address - Country:US
Practice Address - Phone:667-239-3309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOLMAC CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-22
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder