Provider Demographics
NPI:1588902035
Name:ADDICTS CAN BE DISCIPLES TOO
Entity type:Organization
Organization Name:ADDICTS CAN BE DISCIPLES TOO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED FAITH-BASE
Authorized Official - Phone:713-529-2840
Mailing Address - Street 1:3711 SOUTHMORE BLVD APT 1115
Mailing Address - Street 2:1415CUSHING ST
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7948
Mailing Address - Country:US
Mailing Address - Phone:713-659-7700
Mailing Address - Fax:
Practice Address - Street 1:3711 SOUTHMORE BLVD APT 1115
Practice Address - Street 2:1415CUSHING ST
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7948
Practice Address - Country:US
Practice Address - Phone:713-659-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization