11817 LANDRUM INC NPI 1457822538

NPI Information

NPI: 1457822538
Provider Name: 11817 LANDRUM INC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 45D2145711

Address:
3560 DELAWARE ST STE 207
BEAUMONT, TX
ZIP 77706
Phone: (409) 299-8555
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11817 LANDRUM INC is a rehabilitation and substance use disorder clinic center in Beaumont, TX. 11817 LANDRUM INC NPI is 1457822538. The provider is registered as an organization entity type.

The provider's business location address is:

3560 DELAWARE ST STE 207
BEAUMONT, TX
ZIP 77706-059
Phone: (409) 299-8555
Fax: (888) 495-4061

The provider's authorized official is Rick Matthews .
The authorized official title is Ceo and has the following contact phone number (281) 352-5441.

The CLIA number assigned to this NPI record is 45D2145711 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/16/2018 and was last updated on 12/16/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0855X	Clinic/Center	Adolescent and Children Mental Health			No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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