Organization
DALLAS DETOX CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS ADAM PETRILLO (OWNER)
(978) 788-4460
Entity
Organization
Contact information
Practice address
100 MARIAH DR, WEATHERFORD, TX 76087-7408
(888) 979-9503
Mailing address
100 MARIAH DR, WEATHERFORD, TX 76087-7408
(888) 979-9503
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4814-4815
PRIVATE FUNDING
TX
Enumeration date
08/22/2022
Last updated
08/22/2022
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