Provider Demographics
NPI:1669975165
Name:ADDICTION TREATMENT CENTERS LLC
Entity type:Organization
Organization Name:ADDICTION TREATMENT CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEDE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:859-492-0152
Mailing Address - Street 1:118 RUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1256
Mailing Address - Country:US
Mailing Address - Phone:859-492-0152
Mailing Address - Fax:
Practice Address - Street 1:1736 ALEXANDRIA DR STE 225
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3159
Practice Address - Country:US
Practice Address - Phone:859-492-0152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY800271251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health