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General NPI Number Information
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NPI Number | 1124251400
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Entity Type | Organization
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Legal Business Name | LIFETIME RECOVERY
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 96 CROSSROADS BOULEVARD STE 200, 201B, 204, 206, 250
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City | SAN ANTONIO
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State | TX
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Zip | 78201
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Country | US
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Telephone | 210-734-6362
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5968
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City | SAN ANTONIO
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State | TX
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Zip | 78201-0968
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Country | US
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Telephone | 210-734-6362
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Fax | 210-734-6430
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | ELLIANA ESQUIVEL
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Credential |
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Telephone | 210-997-6688
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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 | 10267
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License Number State | TX
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