Basic Information
| Provider Information | |||||||||
| NPI: | 1508276007 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISSION TREATMENT CENTERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7371 PRAIRIE FALCON ROAD | ||||||||
| Address2: | SUITE #110 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198188106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1737 LINWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052396815 | ||||||||
| FaxNumber: | 4052392637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | LEWISON | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6198188106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.