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General NPI Number Information
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NPI Number | 1083087589
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Entity Type | Organization
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Legal Business Name | ON THE PATH TO RECOVERY
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 2119 OAK ST
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City | LA MARQUE
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State | TX
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Zip | 77568-6023
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Country | US
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Telephone | 409-933-4366
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Fax | 409-933-4367
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Provider Business Mailing Address
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Address Line | 2119 OAK ST
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City | LA MARQUE
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State | TX
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Zip | 77568-6023
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Country | US
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Telephone | 409-933-4366
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Fax | 409-933-4367
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TIM HARTWIG
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Credential |
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Telephone | 409-933-4366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1904-1904A
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License Number State | TX
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