Provider Demographics
NPI:1871276105
Name:COBB OUTPATIENT DETOX, LLC
Entity type:Organization
Organization Name:COBB OUTPATIENT DETOX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:ERB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-304-4047
Mailing Address - Street 1:811 LIVINGSTON CT SE STE B
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8958
Mailing Address - Country:US
Mailing Address - Phone:678-439-6441
Mailing Address - Fax:470-857-8728
Practice Address - Street 1:811 LIVINGSTON CT SE STE B
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8958
Practice Address - Country:US
Practice Address - Phone:678-439-6441
Practice Address - Fax:470-857-8728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder