Provider Demographics
NPI:1265858443
Name:KIESHER INSTITUTE OF ADDICTION TREATMENT INC
Entity Type:Organization
Organization Name:KIESHER INSTITUTE OF ADDICTION TREATMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-649-2310
Mailing Address - Street 1:PO BOX 35726
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77235-5726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9888 BISSONNET ST STE 405
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8299
Practice Address - Country:US
Practice Address - Phone:832-649-2310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder