Healthcare Provider Details

I. General information

NPI: 1124577440
Provider Name (Legal Business Name): OBRC OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 ELDER HILL RD
DRIFTWOOD TX
78619-2102
US

IV. Provider business mailing address

1905 ELDER HILL RD
DRIFTWOOD TX
78619-2102
US

V. Phone/Fax

Practice location:
  • Phone: 512-842-6767
  • Fax: 512-842-6766
Mailing address:
  • Phone: 512-842-6767
  • Fax: 512-842-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. VICKI FAUST
Title or Position: CFO
Credential:
Phone: 512-842-6767