Provider Demographics
NPI:1689021735
Name:TAOS ADDICTION TREATMENT SERVICES
Entity Type:Organization
Organization Name:TAOS ADDICTION TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:CAPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-828-3030
Mailing Address - Street 1:1339 PASEO DEL PUEBLO SUR
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5972
Mailing Address - Country:US
Mailing Address - Phone:970-828-3030
Mailing Address - Fax:970-247-0221
Practice Address - Street 1:1339 PASEO DEL PUEBLO SUR
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5972
Practice Address - Country:US
Practice Address - Phone:970-828-3030
Practice Address - Fax:970-247-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone