Healthcare Provider Details

I. General information

NPI: 1235324245
Provider Name (Legal Business Name): COCAINE AND ALCOHOL AWARENESS PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 KNIGHT ARNOLD RD
MEMPHIS TN
38118-2128
US

IV. Provider business mailing address

4041 KNIGHT ARNOLD RD THIRD FLOOR
MEMPHIS TN
38118-2128
US

V. Phone/Fax

Practice location:
  • Phone: 901-367-7550
  • Fax: 901-272-9519
Mailing address:
  • Phone: 901-360-0442
  • Fax: 901-360-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number0000000135
License Number StateTN

VIII. Authorized Official

Name: MR. ALBERT L. RICHARDSON JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: LADAC/NADAC
Phone: 901-360-0442