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General NPI Number Information
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NPI Number | 1043897861
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE OPIOID REHABILITATION PROGRAM, LLC
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 03/28/2021
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Provider Practice Location Address
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Address Line | 3006 BEE CAVES RD STE D-207
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City | AUSTIN
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State | TX
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Zip | 78746-5588
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Country | US
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Telephone | 512-329-0435
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Fax | 512-329-0435
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Provider Business Mailing Address
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Address Line | PO BOX 162047
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City | AUSTIN
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State | TX
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Zip | 78716-2047
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Country | US
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Telephone | 512-329-0435
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MATTHEW EDWARD MASTERS JR.
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Credential | MD
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Telephone | 512-329-0435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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