Healthcare Provider Details

I. General information

NPI: 1619415213
Provider Name (Legal Business Name): INFINITE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7517 CAMERON RD STE #118
AUSTIN TX
78752
US

IV. Provider business mailing address

7517 CAMERON RD STE 118
AUSTIN TX
78752
US

V. Phone/Fax

Practice location:
  • Phone: 512-975-2658
  • Fax:
Mailing address:
  • Phone: 512-975-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number3767-3768
License Number StateTX

VIII. Authorized Official

Name: MARK PETER CRANDALL
Title or Position: COUNSELOR
Credential: LCDC
Phone: 603-781-4629