Healthcare Provider Details

I. General information

NPI: 1629433917
Provider Name (Legal Business Name): OUTCOMES DETOX CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E LOS EBANOS BLVD SUITES 101 AND 108 - 109
BROWNSVILLE TX
78520
US

IV. Provider business mailing address

425 E LOS EBANOS BLVD SUITES 108 - 109
BROWNSVILLE TX
78520-8481
US

V. Phone/Fax

Practice location:
  • Phone: 956-546-3116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRIS A. TRYKA
Title or Position: AR DIRECTOR
Credential:
Phone: 956-546-3116