| Organization Name: | EAST TEXAS TREATMENT CENTER |
| NPI Number: | 1023002425 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CINDY KULAK (EXECUTIVE DIRECTOR) |
| Mailing Address: | 1200 Dudley Rd Kilgore |
| State: | TX US |
| Postal Code: | 756623306 |
| Phone Number: | 9039845571 |
| Fax Number: | 9039841913 |
| NPI Enumeration Date: | 08/31/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0401X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Taxonomy Definition: | |