Provider Demographics
NPI:1225796121
Name:ADDICTION EVICTION LIMITED LIABILITY COMPANY, LLC
Entity Type:Organization
Organization Name:ADDICTION EVICTION LIMITED LIABILITY COMPANY, LLC
Other - Org Name:ADDICTION EVICTION, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHINUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-481-4613
Mailing Address - Street 1:1940 ABERGELDIE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-6303
Mailing Address - Country:US
Mailing Address - Phone:901-481-4613
Mailing Address - Fax:
Practice Address - Street 1:14690 HIGHWAY 194
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-4356
Practice Address - Country:US
Practice Address - Phone:901-481-4613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ066247Medicaid