Provider Demographics
NPI:1053867267
Name:ALCOHOL AND DRUG ABUSE COUNCIL FOR THE CONCHO VALLEY
Entity Type:Organization
Organization Name:ALCOHOL AND DRUG ABUSE COUNCIL FOR THE CONCHO VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:325-224-3481
Mailing Address - Street 1:3553 HOUSTON HARTE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902
Mailing Address - Country:US
Mailing Address - Phone:325-224-3481
Mailing Address - Fax:325-224-4923
Practice Address - Street 1:3553 HOUSTON HARTE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76902
Practice Address - Country:US
Practice Address - Phone:325-224-3481
Practice Address - Fax:325-224-4923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13428324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility