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General NPI Number Information
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NPI Number | 1063834166
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Entity Type | Organization
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Legal Business Name | ALIVE AND WELL RECOVERY CENTER
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 204 S MAIN ST
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City | KELLER
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State | TX
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Zip | 76248-7034
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Country | US
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Telephone | 817-944-7871
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Fax |
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Provider Business Mailing Address
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Address Line | 204 S MAIN ST
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City | KELLER
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State | TX
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Zip | 76248-7034
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Country | US
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Telephone | 817-944-7871
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JOIE LYNNE FRONTZ
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Credential | PRSS
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Telephone | 817-944-7871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | TX
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