Provider Demographics
NPI:1750392692
Name:409 ADDICTION TREATMENT INC
Entity type:Organization
Organization Name:409 ADDICTION TREATMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCAC, LMSW
Authorized Official - Phone:785-571-0482
Mailing Address - Street 1:409 NW 3RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-2639
Mailing Address - Country:US
Mailing Address - Phone:785-571-0482
Mailing Address - Fax:785-571-0222
Practice Address - Street 1:409 NW 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-2639
Practice Address - Country:US
Practice Address - Phone:785-571-0482
Practice Address - Fax:785-571-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200264950AMedicaid