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General NPI Number Information
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NPI Number | 1528362522
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Entity Type | Organization
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Legal Business Name | A.B.O.D.E. TREATMENT, INC.
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 2018 EVANS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-6007
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Country | US
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Telephone | 817-246-8677
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Fax | 817-922-9809
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Provider Business Mailing Address
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Address Line | 2018 EVANS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-6007
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Country | US
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Telephone | 817-246-8677
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Fax | 817-922-9809
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MR. MCKINLEY KNOX
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Credential |
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Telephone | 817-246-8677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 799-799G
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License Number State | TX
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