Provider Demographics
NPI:1043897861
Name:COMPREHENSIVE OPIOID REHABILITATION PROGRAM, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE OPIOID REHABILITATION PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:512-329-0435
Mailing Address - Street 1:PO BOX 162047
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-2047
Mailing Address - Country:US
Mailing Address - Phone:512-329-0435
Mailing Address - Fax:
Practice Address - Street 1:3006 BEE CAVES RD STE D-207
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5588
Practice Address - Country:US
Practice Address - Phone:512-329-0435
Practice Address - Fax:512-329-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility