MEDICARE: A.B.O.D.E. TREATMENT, INC.

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
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	799-799G	TX

General Provider Information

NPI Number	:	1528362522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.B.O.D.E. TREATMENT, INC.

Provider Business Mailing Address
First Line	:	2018 EVANS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-6007
Country	:	US
Telephone Number	:	817-246-8677
Fax Number	:	817-922-9809

Provider Business Practice Location Address
First Line	:	2018 EVANS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-6007
Country	:	US
Telephone Number	:	817-246-8677
Fax Number	:	817-922-9809

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	MR. MCKINLEY KNOX
Credential	:
Telephone Number	:	817-246-8677

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	01/10/2011

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