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General NPI Number Information
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NPI Number | 1639590284
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Entity Type | Organization
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Legal Business Name | EXPANDED OPPORTUNITIES OUTPATIENT DRUG TREATMENT
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Dates
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Enumeration Date | 12/29/2013
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Last Update Date | 12/29/2013
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Provider Practice Location Address
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Address Line | 167 FLOYD ALLEN RD
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City | MONTICELLO
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State | FL
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Zip | 32344-7129
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Country | US
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Telephone | 850-997-6488
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Fax |
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Provider Business Mailing Address
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Address Line | 167 FLOYD ALLEN RD
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City | MONTICELLO
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State | FL
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Zip | 32344-7129
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Country | US
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Telephone | 850-997-6488
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. BARBARA THOMPSON-REDDICK
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Credential |
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Telephone | 850-264-3058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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