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General NPI Number Information
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NPI Number | 1326623455
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Entity Type | Organization
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Legal Business Name | OUTREACH RECOVERY II
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 29466 PINTAIL DR STE 2
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City | EASTON
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State | MD
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Zip | 21601-9324
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Country | US
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Telephone | 410-800-4466
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Fax | 410-705-5024
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Provider Business Mailing Address
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Address Line | 14205 PARK CENTER DR # 201202
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City | LAUREL
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State | MD
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Zip | 20707-5246
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Country | US
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Telephone | 410-800-4466
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ISIAH COLES
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Credential |
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Telephone | 561-502-3978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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