Healthcare Provider Details

I. General information

NPI: 1043897861
Provider Name (Legal Business Name): COMPREHENSIVE OPIOID REHABILITATION PROGRAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 BEE CAVES RD STE D-207
AUSTIN TX
78746-5588
US

IV. Provider business mailing address

PO BOX 162047
AUSTIN TX
78716-2047
US

V. Phone/Fax

Practice location:
  • Phone: 512-329-0435
  • Fax: 512-329-0435
Mailing address:
  • Phone: 512-329-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MATTHEW EDWARD MASTERS JR.
Title or Position: CEO
Credential: MD
Phone: 512-329-0435