PROFESSIONAL HOME DETOX (NPI# 1407134448) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407134448 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL HOME DETOX |
| Practice Address |
8104 County Road 6500 Lubbock TX 79416-9557 |
| Practice Telephone | 8067736575 |
| Mailing Telephone | 8067736575 |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2011-07-25 |
| Authorized Official Name | MRS. COURTNEY CAROLE FULLER (PROGRAM DIRECTOR) |
| Authorized Official Telephone | 8067736575 |
| Authorized Official Credential | BSN, RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
671297 | TX | Ambulatory Health Care Facilities |
| Street Address |
8104 COUNTY ROAD 6500 |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79416-9557 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437437464 | Courtney Carole Fuller | Registered Nurse | 8104 County Road 6500, Lubbock, TX 79416-9557 | 2011-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710502174 | Jordan Lane Thompson | Pharmacist | 6313 4th Street, Lubbock, TX 79416 | 2020-06-11 |
| 1821636481 | Chieh-an Chou | Specialist/Technologist | 201 N Winston Ave, Lubbock, TX 79416 | 2019-12-13 |
| 1790341949 | Michael Mcpherson, M.d. P.a. | Internal Medicine | 5406 Colgate St, Lubbock, TX 79416 | 2019-05-14 |
| 1154893675 | South Plains Rehabilitation Hospital, LLC | Rehabilitation Hospital | 5406 Colgate Street, Lubbock, TX 79416 | 2018-12-21 |
| 1932697182 | Timothy Sampana | Student in an Organized Health Care Education/Training Program | 5217 Lehigh St, Lubbock, TX 79416 | 2018-04-24 |
| 1306347711 | 4th Street Dental, Pllc | Dentist | 5709 4th St, Lubbock, TX 79416 | 2018-02-22 |
| 1639682503 | South Plains Surgery Center LLC | Clinic/Center | 4412 6th Street, Lubbock, TX 79416 | 2017-11-14 |
| 1013459809 | Isabel Garcia | Occupational Therapy Assistant | 1717 Northfolk Ave, #a, Lubbock, TX 79416 | 2016-11-09 |
| 1033589213 | Rehab Care | Skilled Nursing Facility | 1717 Norfork Ave, Bldg A, Lubbock, TX 79416 | 2015-10-01 |
| 1902281306 | Carrillon | Clinic/Center | 1717 Norfold Bld A, Lubbock, TX 79416 | 2015-07-27 |
| Find all providers in zip 79416 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245602994 | Stages of Recovery, Inc | Clinic/Center | 4413 71st St Ste G101, Lubbock, TX 79424-2319 | 2015-10-21 |
| 1356627624 | Aspire Addiction Recovery Center LLC | Clinic/Center | 3330 70th St Ste 120, Lubbock, TX 79413-6136 | 2011-10-31 |
| 1992708705 | Lubbock Regional Mhmr Center | Clinic/Center | 904 Avenue O, Lubbock, TX 79401-3924 | 2005-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548860406 | Dfw Drug Rehab, LLC | Clinic/Center | 1251 S Sherman St Ste 110, Richardson, TX 75081-6509 | 2020-10-29 |
| 1316553019 | Trinity Health System | Clinic/Center | 13101 Preston Rd Ste 425, Dallas, TX 75240-5278 | 2020-09-17 |
| 1548881683 | South Meadows Recovery, Inc. | Clinic/Center | 15505 Patrica St, Austin, TX 78728-3923 | 2020-04-29 |
| 1376178053 | Liberty Lodge, Inc. | Clinic/Center | 160 Fm 2507, Alice, TX 78332-7763 | 2020-03-03 |
| 1730713769 | Cen-tex Alcoholic Rehabilitation Center, Inc. | Clinic/Center | 2410 E Adams Ave, Temple, TX 76501-4600 | 2020-02-28 |
| 1154953917 | Finch Clinic, Pllc. | Clinic/Center | 1105 Memorial Dr Ste 102, Denison, TX 75020-2043 | 2020-02-10 |
| 1265063689 | Cenikorfoundation | Clinic/Center | 5501 Interstate Hwy 37, Corpus Christi, TX 78408 | 2020-02-04 |
| 1598306862 | Ethos Wellness-the Prairie Recovery Center | Clinic/Center | 5808 Wagner Rd, Round Top, TX 78954-5075 | 2019-10-08 |
| 1619539509 | Arc Counseling LLC | Clinic/Center | 5700 Nw Central Dr Ste 130, Houston, TX 77092-2000 | 2019-07-01 |
| 1982261988 | Davecolephd and Associates | Clinic/Center | 4702 Old Spanish Trl Ste 106, Houston, TX 77021-1718 | 2019-05-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.