Provider Demographics
NPI:1225618507
Name:MTR TREATMENT CORP
Entity Type:Organization
Organization Name:MTR TREATMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SHINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-485-5451
Mailing Address - Street 1:112 E LINE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-5760
Mailing Address - Country:US
Mailing Address - Phone:979-485-5451
Mailing Address - Fax:979-704-5008
Practice Address - Street 1:112 E LINE ST STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5760
Practice Address - Country:US
Practice Address - Phone:979-485-5451
Practice Address - Fax:979-704-5008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MTR TREATMENT CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility