Healthcare Provider Details

I. General information

NPI: 1548652910
Provider Name (Legal Business Name): AUSTIN RECORERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 EXECUTIVE CENTER DR
AUSTIN TX
78731-1624
US

IV. Provider business mailing address

3420 EXECUTIVE CENTER DR
AUSTIN TX
78731-1624
US

V. Phone/Fax

Practice location:
  • Phone: 920-216-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number32450000X
License Number StateTX

VIII. Authorized Official

Name: CRYSTLYN MROCZENSKI
Title or Position: COLLABORATIVE COUNSELOR
Credential:
Phone: 920-216-8700