Provider Demographics
NPI:1114244167
Name:TOXICOLOGY ASSOCIATES, INC
Entity Type:Organization
Organization Name:TOXICOLOGY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:713-541-3218
Mailing Address - Street 1:6910 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3509
Mailing Address - Country:US
Mailing Address - Phone:713-541-3218
Mailing Address - Fax:713-541-3217
Practice Address - Street 1:2411 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-6303
Practice Address - Country:US
Practice Address - Phone:409-935-3749
Practice Address - Fax:409-935-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000009261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone