Healthcare Provider Details

I. General information

NPI: 1720668049
Provider Name (Legal Business Name): OUTREACH RECOVERY II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 NE 191ST ST STE 300
MIAMI FL
33180-3115
US

IV. Provider business mailing address

4201 NORTHVIEW DR STE 104
BOWIE MD
20716-2655
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-4466
  • Fax:
Mailing address:
  • Phone: 410-800-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ISIAH COLES
Title or Position: COO
Credential:
Phone: 561-502-3978