Organization
ST. MONICA'S OUTREACH CENTER FOR ADDICTIVE DISORDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANY A CHERIAN M.D. (PRESIDENT)
(979) 779-4756
Entity
Organization
Contact information
Practice address
1703 E 29TH ST, BRYAN, TX 77802-1406
(979) 779-4756
(979) 823-3018
Mailing address
1703 E 29TH ST, BRYAN, TX 77802-1406
(979) 779-4756
(979) 823-3018
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
3474-3475
TX
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
3474-3475
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3474-3475
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
TX
Enumeration date
11/15/2011
Last updated
11/15/2011
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