Provider Demographics
NPI:1003511213
Name:ANCHOR OF HOPE OPIOID TREATMENT PROGRAM INC
Entity Type:Organization
Organization Name:ANCHOR OF HOPE OPIOID TREATMENT PROGRAM INC
Other - Org Name:ANCHOR OF HOPE OTP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MODKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:469-291-5288
Mailing Address - Street 1:2307 SPRINGLAKE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-5876
Mailing Address - Country:US
Mailing Address - Phone:469-291-5288
Mailing Address - Fax:469-291-5443
Practice Address - Street 1:2307 SPRINGLAKE RD STE 500
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-5876
Practice Address - Country:US
Practice Address - Phone:469-291-5288
Practice Address - Fax:469-291-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty