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General NPI Number Information
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NPI Number | 1629433917
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Entity Type | Organization
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Legal Business Name | OUTCOMES DETOX CENTER, LLC
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 425 E LOS EBANOS BLVD SUITES 101 AND 108 - 109
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City | BROWNSVILLE
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State | TX
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Zip | 78520
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Country | US
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Telephone | 956-546-3116
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Fax |
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Provider Business Mailing Address
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Address Line | 425 E LOS EBANOS BLVD SUITES 108 - 109
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City | BROWNSVILLE
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State | TX
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Zip | 78520-8481
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AR DIRECTOR
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Name | CHRIS A. TRYKA
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Credential |
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Telephone | 956-546-3116
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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 |
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License Number State |
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Taxonomy #2
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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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