Provider Demographics
NPI:1295037885
Name:ADDICTION ALTERNATIVES FOR OPIATE--HEROIN, INC.
Entity Type:Organization
Organization Name:ADDICTION ALTERNATIVES FOR OPIATE--HEROIN, INC.
Other - Org Name:ADD-LIFE RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENTINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:903-596-0606
Mailing Address - Street 1:3322 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5144
Mailing Address - Country:US
Mailing Address - Phone:903-596-0606
Mailing Address - Fax:903-596-0661
Practice Address - Street 1:3322 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5144
Practice Address - Country:US
Practice Address - Phone:903-596-0606
Practice Address - Fax:903-596-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000109261QM2800X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone