Provider Demographics
NPI:1043731987
Name:ANOTHER ROAD DETOX
Entity Type:Organization
Organization Name:ANOTHER ROAD DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF TREATMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:CADTP/CAODC
Authorized Official - Phone:805-266-3747
Mailing Address - Street 1:113 SOUTH M STREET
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436
Mailing Address - Country:US
Mailing Address - Phone:805-736-0357
Mailing Address - Fax:866-929-9350
Practice Address - Street 1:113 SOUTH M STREET
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-736-0357
Practice Address - Fax:866-929-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty