Provider Demographics
NPI:1508167529
Name:SOUTH TEXAS COUNCIL ON ALCOHOLAND DRUG ABUSE
Entity Type:Organization
Organization Name:SOUTH TEXAS COUNCIL ON ALCOHOLAND DRUG ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-722-1135
Mailing Address - Street 1:2359 E SAUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5434
Mailing Address - Country:US
Mailing Address - Phone:956-284-2127
Mailing Address - Fax:
Practice Address - Street 1:906 HIDALGO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076-3968
Practice Address - Country:US
Practice Address - Phone:956-765-1075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX787-P261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder