Healthcare Provider Details

I. General information

NPI: 1790791697
Provider Name (Legal Business Name): TAOS RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 BLUEBERRY HILL RD
EL PRADO NM
87529-7305
US

IV. Provider business mailing address

235 W HICKORY ST STE 201
DENTON TX
76201-4122
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-5858
  • Fax:
Mailing address:
  • Phone: 940-383-2843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number5633
License Number StateNM

VIII. Authorized Official

Name: MR. BLAKE BROWDER
Title or Position: PRESIDENT
Credential:
Phone: 575-758-5858