Provider Demographics
NPI:1790043404
Name:MANAGED CARE CENTER FOR ADDICTIVE AND OTHER DISORDERS INC
Entity Type:Organization
Organization Name:MANAGED CARE CENTER FOR ADDICTIVE AND OTHER DISORDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/ PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:806-797-8003
Mailing Address - Street 1:1715 26TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79411-1524
Mailing Address - Country:US
Mailing Address - Phone:806-780-8300
Mailing Address - Fax:
Practice Address - Street 1:1705 N FM 179
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-9441
Practice Address - Country:US
Practice Address - Phone:806-797-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10889305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065363601Medicaid