| Entity Name: | OUTREACH RECOVERY II, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 05 Apr 2021 (4 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | REVOKED FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | M21000003877 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 4201 NORTHVIEW DR. #104, BOWIE, MD, 20716, US |
| Mail Address: | 4201 NORTHVIEW DR. #104, BOWIE, MD, 20716, US |
| Place of Formation: | MARYLAND |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720668049 | 2021-04-12 | 2021-04-12 | 4201 NORTHVIEW DR STE 104, BOWIE, MD, 207162655, US | 801 SE 6TH AVE STE 202C, DELRAY BEACH, FL, 334835185, US | |||||||||||||||||||||||||||
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| Phone | +1 410-800-4466 |
Authorized person
| Name | ISIAH COLES |
| Role | COO |
| Phone | 5615023978 |
Taxonomy
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 207RA0401X - Addiction Medicine (Internal Medicine) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100142379 |
| State | MD |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| ABDESHAHIAN EHSAN | Authorized Person | 774 GIRARD ST. NW #7W, WASHINGTON, DC, 20001 |
| Name | Role | Address |
|---|---|---|
| FREAS DAMEAN | Member | 1705 MISSION RIDGE RD., ANNAPOLIS, MD, 21401 |
| LEE YOUNG | Member | 6 CARLTON LN., VORHEES, NJ, 08043 |
| THAM WILLIAM | Member | 786 SONNE DR., ANNAPOLIS, MD, 21401 |
| PUREWAL MITES | Member | 200 W. HARTRANTH BLVD., NORRISTOWN, PA, 19401 |
| PUREWAL UPLEKH | Member | 200 W. HARTRANTH BLVD., NORRISTOWN, PA, 19401 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REVOKED FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-03-11 |
| Foreign Limited | 2021-04-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
