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NPI Code Detail

MEDICARE: ALCOHOL & DRUG ABUSE COUNCIL FOR THE CONCHO VALLEY

MEDICARE: ALCOHOL & DRUG ABUSE COUNCIL FOR THE CONCHO VALLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility292-BTX
2324500000XSubstance Abuse Rehabilitation Facility292-ETX
3324500000XSubstance Abuse Rehabilitation Facility292-CTX
4261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center292CTX

General Provider Information

NPI Number : 1093031148
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALCOHOL & DRUG ABUSE COUNCIL FOR THE CONCHO VALLEY
Provider Business Mailing Address
First Line : PO BOX 3805
Second Line :
City : SAN ANGELO
State : TX
Zip : 76902-3805
Country : US
Telephone Number : 325-224-3481
Fax Number : 325-224-4923
Provider Business Practice Location Address
First Line : 3553 W HOUSTON HARTE EXPY
Second Line :
City : SAN ANGELO
State : TX
Zip : 76901-2664
Country : US
Telephone Number : 325-224-3481
Fax Number : 325-224-4923
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. ERIC A SANCHEZ
Credential :
Telephone Number : 325-224-3481
Provider Enumeration Date : 04/14/2010
Last Update Date : 07/16/2010

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Directions to “ALCOHOL & DRUG ABUSE COUNCIL FOR THE CONCHO VALLEY ” Practice Location

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