Provider Demographics
NPI:1528362522
Name:A.B.O.D.E. TREATMENT, INC.
Entity Type:Organization
Organization Name:A.B.O.D.E. TREATMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MCKINLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-246-8677
Mailing Address - Street 1:2018 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-6007
Mailing Address - Country:US
Mailing Address - Phone:817-246-8677
Mailing Address - Fax:817-922-9809
Practice Address - Street 1:2018 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-6007
Practice Address - Country:US
Practice Address - Phone:817-246-8677
Practice Address - Fax:817-922-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX799-799G261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder