Provider Demographics
NPI:1205577327
Name:NEUROSCIENCE INSTITUTE ON ADDICTION
Entity type:Organization
Organization Name:NEUROSCIENCE INSTITUTE ON ADDICTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS/MD/PHD22
Authorized Official - Phone:954-260-0104
Mailing Address - Street 1:142 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-2501
Mailing Address - Country:US
Mailing Address - Phone:954-260-0104
Mailing Address - Fax:
Practice Address - Street 1:142 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-2501
Practice Address - Country:US
Practice Address - Phone:954-260-0104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUD FACILITY OPTIMIZATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty