# FORT WORTH DETOX LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053274910
- **Authorized official:** COLIN MCBRIDE (CRO)
- **Authorized official phone:** (631) 672-7441

## Contact information

- **Practice address:** 101 MARIAH DR, WEATHERFORD, TX 76087-7400
- **Practice address phone:** (978) 440-3200
- **Practice address fax:** (323) 529-8134
- **Mailing address:** 5201 CONGRESS AVE STE 275, BOCA RATON, FL 33487-3609
- **Mailing address phone:** (978) 440-3200
- **Mailing address fax:** (323) 529-8134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |

## Other

- **Enumeration date:** 12/08/2025
- **Last updated:** 07/27/2026