OrganizationActive
Outreach Recovery II, LLC
NPI 1801452362 · Addiction Medicine (Preventive Medicine) Physician · Waldorf, MD
Provider details
- NPI number
- 1801452362
- Entity type
- Organization
- Primary specialty
- Addiction Medicine (Preventive Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Isiah Coles, Coo(561) 502-3978
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
Physician Assistants & Advanced Practice Nursing Providers
Practice location
11340 Pembrooke Sq Ste 214
Waldorf, MD 20603-4808
Phone: (410) 800-4466
Approximate (ZIP-level) locationGet directions
Mailing address
14205 Park Center Dr # 201202
Laurel, MD 20707-5246
Registry dates
- Enumerated
- 2019-05-10
- Last updated
- 2024-07-31
- Certified
- 2024-07-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.