Healthcare Provider Details

I. General information

NPI: 1215741525
Provider Name (Legal Business Name): VITAL STEPS RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLIVE ST STE 507
TEXARKANA AR
71854-5920
US

IV. Provider business mailing address

300 OLIVE ST STE 507
TEXARKANA AR
71854-5920
US

V. Phone/Fax

Practice location:
  • Phone: 870-330-0902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CODY PHIPPS
Title or Position: CEO
Credential:
Phone: 870-330-0902