MEDICARE: CSMN OPERATIONS TX, 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

General Provider Information

NPI Number	:	1962289280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSMN OPERATIONS TX, LLC

Provider Business Mailing Address
First Line	:	5637 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7321
Country	:	US
Telephone Number	:	432-553-9227
Fax Number	:

Provider Business Practice Location Address
First Line	:	5637 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7321
Country	:	US
Telephone Number	:	432-553-9227
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. NICHOLE DANLEY
Credential	:	LCDC
Telephone Number	:	432-553-9227

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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Directions to “CSMN OPERATIONS TX, LLC ” Practice Location

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