Provider Demographics
NPI:1629433917
Name:OUTCOMES DETOX CENTER, LLC
Entity Type:Organization
Organization Name:OUTCOMES DETOX CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRYKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-546-3116
Mailing Address - Street 1:425 E LOS EBANOS BLVD
Mailing Address - Street 2:SUITES 108 - 109
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8481
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 E LOS EBANOS BLVD
Practice Address - Street 2:SUITES 101 AND 108 - 109
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-546-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381185301Medicaid