Provider Demographics
NPI:1154190692
Name:ADDICTION MANAGEMENT LLC
Entity type:Organization
Organization Name:ADDICTION MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERENATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-509-5000
Mailing Address - Street 1:3015 E SKELLY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6344
Mailing Address - Country:US
Mailing Address - Phone:918-509-5000
Mailing Address - Fax:
Practice Address - Street 1:3015 E SKELLY DR STE 103
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6344
Practice Address - Country:US
Practice Address - Phone:918-509-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty