Provider Demographics
NPI:1518492362
Name:STONEWATER ADDICTION RECOVERY CENTER
Entity Type:Organization
Organization Name:STONEWATER ADDICTION RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-372-1691
Mailing Address - Street 1:38 COUNTY ROAD 362
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 COUNTY ROAD 362
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-8514
Practice Address - Country:US
Practice Address - Phone:662-259-8474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONEWATER ADDICTION RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-28
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health