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General NPI Number Information
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NPI Number | 1750415477
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Entity Type | Organization
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Legal Business Name | ALCOHOLIC SERVICES OF TEXOMA
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2407 TEXOMA PKWY
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City | SHERMAN
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State | TX
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Zip | 75090-2421
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Country | US
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Telephone | 903-868-2123
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Fax | 903-868-0168
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | SHERMAN
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State | TX
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Zip | 75091-0069
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Country | US
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Telephone | 903-868-2123
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Fax | 903-868-0168
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT MORROW STOOLFIRE
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Credential |
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Telephone | 903-870-6444
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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 | 231A & 231B
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License Number State | TX
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