OUTREACH RECOVERY II LLC NPI 1801452362

NPI Information

  • NPI: 1801452362
  • Provider Name: OUTREACH RECOVERY II, LLC
  • Classification: Preventive Medicine - 2083A0300X
  • Specialization: Addiction Medicine
  • Entity Type: Organization
  • Address: 11340 PEMBROOKE SQ STE 214
    WALDORF, MD
    ZIP 20603
  • Phone: (410) 800-4466

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NPI Details

OUTREACH RECOVERY II, LLC is an addiction medicine preventive medicine in Waldorf, MD. The provider is a physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction. OUTREACH RECOVERY II, LLC NPI is 1801452362. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

11340 PEMBROOKE SQ STE 214
WALDORF, MD
ZIP 20603-808
Phone: (410) 800-4466

The provider's authorized official is Isiah Coles .
The authorized official title is Coo and has the following contact phone number (561) 502-3978.

The enumeration date for this NPI number is 5/10/2019 and was last updated on 7/31/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineNo
22083A0300XPreventive MedicineAddiction MedicineYes
3364SP0809XClinical Nurse SpecialistPsychiatric/Mental Health, AdultNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1777797300MEDICAIDMARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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