Provider Demographics
NPI:1528368081
Name:ADDICTION SERVICES CS, LLC
Entity Type:Organization
Organization Name:ADDICTION SERVICES CS, LLC
Other - Org Name:MEDPRO TREATMENT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-599-9450
Mailing Address - Street 1:1103 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2357
Mailing Address - Country:US
Mailing Address - Phone:979-599-9450
Mailing Address - Fax:979-599-9451
Practice Address - Street 1:1103 UNIVERSITY DR E
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2357
Practice Address - Country:US
Practice Address - Phone:979-599-9450
Practice Address - Fax:979-599-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000020261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone