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General NPI Number Information
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NPI Number | 1609167469
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Entity Type | Organization
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Legal Business Name | NORTH DALLAS DRUG REHABILITATION CENTER
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1606 S I 35 STE 101
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City | CARROLLTON
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State | TX
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Zip | 75006-7478
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Country | US
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Telephone | 972-446-0972
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 S I 35 STE 101
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City | CARROLLTON
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State | TX
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Zip | 75006-7478
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Country | US
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Telephone | 972-446-0972
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Fax |
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Authorized Official
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Title or Position | SPONSOR
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Name | MR. MICHAEL S ACEVES SR.
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Credential | LCDC
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Telephone | 972-446-0972
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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 | TX10127M
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License Number State | TX
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