Organization
ST. GENEVIEVE DETOX AND MAINTENANCE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IKENNA OBUEKWE (ADMINISTRATOR)
(346) 422-4475
Entity
Organization
Contact information
Practice address
141 BRAZOSPORT BLVD N, CLUTE, TX 77531-3745
(979) 265-0705
(979) 265-1178
Mailing address
141 BRAZOSPORT BLVD N, CLUTE, TX 77531-3745
(979) 265-0705
(979) 265-1178
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
12/16/2024
Last updated
05/12/2026
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