OUTREACH RECOVERY II, LLC (NPI# 1801452362) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801452362 |
| Entity Type | Organization |
| Organization Name | OUTREACH RECOVERY II, LLC |
| Practice Address |
3649 Leonardtown Rd Waldorf MD 20601-3626 |
| Mailing Address |
4201 Northview Dr Ste 104 Bowie MD 20716-2604 |
| Practice Telephone | 4108004466 |
| Mailing Telephone | 4108004466 |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2020-01-02 |
| Authorized Official Name | ISIAH COLES (COO) |
| Authorized Official Telephone | 5615023978 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 364SP0809X |
Clinical Nurse Specialist Specialization: Psych/Mental Health, Adult |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2083A0300X |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 777797300 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 21 Industrial Park Dr # 203g107, Waldorf, MD 206022751 | 4104298690 | |
| 3825 Leonardtown Rd, Waldorf, MD 206013693 | 4108004466 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760090294 | Outreach Recovery II, LLC | Internal Medicine | 339 E Antietam St Ste 4, Hagerstown, MD 21740-5767 | 2020-07-21 |
| 1679198667 | Outreach Recovery II, LLC | Counselor | 72 Greene St Ste 104, Cumberland, MD 21502-2933 | 2020-06-15 |
| 1427541838 | Outreach Recovery II, LLC | Internal Medicine | 4201 Northview Dr Ste 104, Bowie, MD 20716 | 2018-06-11 |
| 1023626553 | Outreach Recovery II, LLC | Counselor | 339 E Antietam St Ste 4, Hagerstown, MD 21740-5767 | 2020-07-21 |
| 1518584143 | Outreach Recovery II, LLC | Counselor | 915 Toll House Ave Ste 102, Frederick, MD 21701-5911 | 2020-06-30 |
| 1821614157 | Outreach Recovery II, LLC | Family Medicine | 72 Greene St, Cumberland, MD 21502-2933 | 2020-06-23 |
| 1386260990 | Outreach Recovery II, LLC | Internal Medicine | 30 W Gude Dr Ste 375, Rockville, MD 20850-4300 | 2020-06-19 |
| 1639795248 | Outreach Recovery II, LLC | Counselor | 30 W Gude Dr Ste 375, Rockville, MD 20850-4300 | 2020-06-19 |
| 1568087559 | Outreach Recovery II, LLC | Counselor | 4201 Northview Dr Ste 104, Bowie, MD 20716-2655 | 2020-06-15 |
| 1003431099 | Outreach Recovery II, LLC | Counselor | 3649 Leonardtown Rd, Waldorf, MD 20601-3626 | 2020-06-15 |
| Street Address |
3649 LEONARDTOWN RD |
| City | WALDORF |
| State | MD |
| Zip Code | 20601-3626 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003431099 | Outreach Recovery II, LLC | Counselor | 3649 Leonardtown Rd, Waldorf, MD 20601-3626 | 2020-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154960128 | Sarian Beverly Wilson | Nurse Practitioner | 2203 Kayhill Dr, Waldorf, MD 20601 | 2019-12-23 |
| 1447778055 | Macy Alexandra Forman | Pharmacist | 3061 Tecnology Place, Waldorf, MD 20601 | 2017-09-04 |
| 1922523919 | Gregoire Mcclain | Counselor | Pathways Inc 2670 Crain Hwy, Suite 409, Waldorf, MD 20601 | 2017-08-10 |
| 1477091866 | Lutisse Cooper | Home Health Aide | 2520 Breakwater Court, Waldorf, MD 20601 | 2017-02-06 |
| 1609321637 | Kierra Jordan | Counselor | 2255 Crain Hwy Ste 102, Waldorf, MD 20601 | 2016-08-19 |
| 1215286828 | Linda Kline-lau | Counselor | 2255 Crain Highway, Waldorf, MD 20601 | 2012-08-29 |
| 1205124609 | Marian E. Kirk | Physical Therapist | 2960 Technology Place, Suite 110, Waldorf, MD 20601 | 2011-07-19 |
| 1932345238 | Patient First Maryland Medical Group | Non-Pharmacy Dispensing Site | 2855 Crain Highway, Waldorf, MD 20601 | 2008-12-17 |
| 1720150741 | Marianna Jeanne Patente | Counselor | 2670 Crain Highway, Suite #401, Waldorf, MD 20601 | 2006-11-14 |
| 1407940968 | Harold J. Pincus | Dentist | 2955 Crain Hwy., Waldorf, MD 20601 | 2006-10-02 |
| Find all providers in zip 20601 | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.