Healthcare Provider Details

I. General information

NPI: 1659566404
Provider Name (Legal Business Name): AUSTIN RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 S CONGRESS AVE STE 202
AUSTIN TX
78745
US

IV. Provider business mailing address

4201 S CONGRESS AVE STE 202
AUSTIN TX
78745-1156
US

V. Phone/Fax

Practice location:
  • Phone: 512-697-8500
  • Fax: 512-821-1755
Mailing address:
  • Phone: 512-697-8500
  • Fax: 512-821-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number286-286Y
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number286-286B
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number286-L
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number286-286Y
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number286-286B
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number286-286L
License Number StateTX

VIII. Authorized Official

Name: DIANA VAN BRUNT
Title or Position: BUSINESS ADMINISTRATION MANAGER
Credential:
Phone: 512-697-8518