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General NPI Number Information
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NPI Number | 1124464136
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Entity Type | Organization
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Legal Business Name | VCPHCS XXII, LLC
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 105 E BREMOND AVE
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City | LUFKIN
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State | TX
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Zip | 75901-3025
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Country | US
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Telephone | 936-637-2223
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Fax | 936-637-2220
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Provider Business Mailing Address
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Address Line | 8300 DOUGLAS AVE SUITE 750
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City | DALLAS
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State | TX
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Zip | 75225-5603
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Country | US
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Telephone | 214-365-6100
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Fax | 214-365-6150
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Authorized Official
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Title or Position | COO
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Name | MR. JAMES FREDERICK DRAUDT
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Credential |
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Telephone | 214-365-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 1000038
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License Number State | TX
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