Provider Demographics
NPI:1336479682
Name:ROSWELL ADDICTION TREATMENT
Entity Type:Organization
Organization Name:ROSWELL ADDICTION TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:913-957-3596
Mailing Address - Street 1:1401 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-2845
Mailing Address - Country:US
Mailing Address - Phone:913-387-4773
Mailing Address - Fax:913-621-2297
Practice Address - Street 1:1401 N 18TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-2845
Practice Address - Country:US
Practice Address - Phone:913-387-4773
Practice Address - Fax:913-621-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07070894261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care