Healthcare Provider Details

I. General information

NPI: 1285400499
Provider Name (Legal Business Name): OPIATE RECOVERY CENTER OF ADDICTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 SPUR 156
WASKOM TX
75692-9129
US

IV. Provider business mailing address

670 SPUR 156
WASKOM TX
75692-9129
US

V. Phone/Fax

Practice location:
  • Phone: 903-687-2300
  • Fax: 903-687-2304
Mailing address:
  • Phone: 903-687-2300
  • Fax: 903-687-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MS. TOYIA D. LANDRENEAUX
Title or Position: PROGRAM SPONSOR
Credential: LVN
Phone: 903-687-3800