Provider Demographics
NPI:1184880734
Name:INSIGHT TREATMENT PROGRAM, INC
Entity type:Organization
Organization Name:INSIGHT TREATMENT PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS
Authorized Official - Phone:251-473-6093
Mailing Address - Street 1:1111 E I65 SERVICE RD S
Mailing Address - Street 2:SUITE A-7
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3112
Mailing Address - Country:US
Mailing Address - Phone:251-473-6093
Mailing Address - Fax:251-473-6469
Practice Address - Street 1:100 COURT ST
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451-3263
Practice Address - Country:US
Practice Address - Phone:251-275-3036
Practice Address - Fax:251-275-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder