Provider Demographics
NPI:1780890210
Name:METRO TREATMENT OF MISSOURI, LP
Entity type:Organization
Organization Name:METRO TREATMENT OF MISSOURI, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-581-5157
Mailing Address - Street 1:2500 MAITLAND CENTER PARKWAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4174
Mailing Address - Country:US
Mailing Address - Phone:407-351-7080
Mailing Address - Fax:407-351-6930
Practice Address - Street 1:9733 ST CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:BRECKINRIDGE HILLS
Practice Address - State:MO
Practice Address - Zip Code:63114-2625
Practice Address - Country:US
Practice Address - Phone:314-423-7030
Practice Address - Fax:314-423-9511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO TREATMENT OF MISSOURI, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
MO29683336C0002X
MO3125-6924251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No3336C0002XSuppliersPharmacyClinic Pharmacy