Provider Demographics
NPI:1093031148
Name:ALCOHOL & DRUG ABUSE COUNCIL FOR THE CONCHO VALLEY
Entity Type:Organization
Organization Name:ALCOHOL & DRUG ABUSE COUNCIL FOR THE CONCHO VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-224-3481
Mailing Address - Street 1:PO BOX 3805
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-3805
Mailing Address - Country:US
Mailing Address - Phone:325-224-3481
Mailing Address - Fax:325-224-4923
Practice Address - Street 1:3553 W HOUSTON HARTE EXPY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-2664
Practice Address - Country:US
Practice Address - Phone:325-224-3481
Practice Address - Fax:325-224-4923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALCOHOL & DRUG ABUSE COUNCIL FOR THE CONCHO VALLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-14
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292C261QR0405X
TX292-B324500000X
TX292-E324500000X
TX292-C324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility