1962829408 NPI number — RECOVERY COMMUNITIES OF CULTURE

Table of content: (NPI 1962829408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962829408 NPI number — RECOVERY COMMUNITIES OF CULTURE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY COMMUNITIES OF CULTURE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962829408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3472
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75019-9472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
778-257-2282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1236 SOUTHRIDGE CT STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76053-4284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-252-2282
Provider Business Practice Location Address Fax Number:
877-252-2282
Provider Enumeration Date:
03/22/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POWELL
Authorized Official First Name:
ANNIE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
877-257-2282

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  9710 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 175T00000X , with the licence number: 061713 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 380106001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".