NPIMap

Organization Active NPI

Kolmac Clinic, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Towson, MD
National Provider Identifier
1275155335
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
KOLMAC CLINIC, LLC
Practice address
6525 N Charles St Ste 85
Towson, MD 21204-6872
Phone
(301) 589-0255
NPI assigned
May 12, 2020
Organization subpart
Yes
Parent organization
KOLMAC CLINIC, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Clark
Title
Chief Admin Officer
Phone
(301) 589-0255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

6525 N Charles St Ste 85
Towson, MD 21204-6872

Mailing address

3919 National Dr Ste 300
Burtonsville, MD 20866-1180
Phone (301) 589-0255

Other names 1

  • Kolmac Outpatient Recovery Centers Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kolmac Clinic4 organizations share this tax ID, including this one
Part of
Kolmac Clinic

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3919 National Dr
Ste 300
Burtonsville, MD 20866

6525 N Charles St
Ste 85
Towson, MD 21204
Phone (410) 296-2232

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1275155335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 NATIONAL DR STE 300",
            "city": "BURTONSVILLE",
            "state": "MD",
            "postal_code": "208661180",
            "telephone_number": "301-589-0255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 N CHARLES ST STE 85",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212046872",
            "telephone_number": "301-589-0255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOLMAC CLINIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KOLMAC CLINIC, LLC",
        "enumeration_date": "2020-05-12",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF ADMIN OFFICER",
        "authorized_official_telephone_number": "301-589-0255"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kolmac Outpatient Recovery Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Towson, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.