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General NPI Number Information
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NPI Number | 1285400499
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Entity Type | Organization
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Legal Business Name | OPIATE RECOVERY CENTER OF ADDICTION, LLC
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 670 SPUR 156
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City | WASKOM
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State | TX
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Zip | 75692-9129
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Country | US
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Telephone | 903-687-2300
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Fax | 903-687-2304
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Provider Business Mailing Address
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Address Line | 670 SPUR 156
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City | WASKOM
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State | TX
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Zip | 75692-9129
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Country | US
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Telephone | 903-687-2300
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Fax | 903-687-2304
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Authorized Official
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Title or Position | PROGRAM SPONSOR
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Name | MS. TOYIA D. LANDRENEAUX
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Credential | LVN
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Telephone | 903-687-3800
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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 |
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License Number State |
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