MEDICARE: MILESTONE TREATMENT CENTERS, LLC

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	71047	TX

General Provider Information

NPI Number	:	1790158384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONE TREATMENT CENTERS, LLC

Provider Business Mailing Address
First Line	:	412 N MAIN ST
Second Line	:	209
City	:	EULESS
State	:	TX
Zip	:	76039-3652
Country	:	US
Telephone Number	:	817-919-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 N MAIN ST
Second Line	:	209
City	:	EULESS
State	:	TX
Zip	:	76039-3652
Country	:	US
Telephone Number	:	817-919-6674
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. RON STEIN
Credential	:	LPC
Telephone Number	:	817-919-6674

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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