Provider Demographics
NPI:1114430907
Name:COMPREHENSIVE ADDICTION TREATMENT LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE ADDICTION TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-559-3954
Mailing Address - Street 1:23 BROWN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-2823
Mailing Address - Country:US
Mailing Address - Phone:401-559-3954
Mailing Address - Fax:401-615-8503
Practice Address - Street 1:1950 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:N KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-6639
Practice Address - Country:US
Practice Address - Phone:401-559-3954
Practice Address - Fax:401-615-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08308261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder