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General NPI Number Information
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NPI Number | 1871828012
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Entity Type | Organization
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Legal Business Name | QUEEN TREATMENT CENTERS INC
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 10 LADY AVE P.O. 978
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City | JACKSON
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State | OH
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Zip | 45640-1018
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Country | US
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Telephone | 740-418-1487
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 978 P.O. 978
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City | JACKSON
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State | OH
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Zip | 45640-0978
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Country | US
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Telephone | 740-418-1487
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. YOLANDA LYNN QUEEN
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Credential | B.S.
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Telephone | 740-286-5713
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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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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 | 324500000X
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License Number State | OH
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