Provider Demographics
NPI:1285400499
Name:OPIATE RECOVERY CENTER OF ADDICTION, LLC
Entity type:Organization
Organization Name:OPIATE RECOVERY CENTER OF ADDICTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TOYIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANDRENEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:903-687-3800
Mailing Address - Street 1:670 SPUR 156
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-9129
Mailing Address - Country:US
Mailing Address - Phone:903-687-2300
Mailing Address - Fax:903-687-2304
Practice Address - Street 1:670 SPUR 156
Practice Address - Street 2:
Practice Address - City:WASKOM
Practice Address - State:TX
Practice Address - Zip Code:75692-9129
Practice Address - Country:US
Practice Address - Phone:903-687-2300
Practice Address - Fax:903-687-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone