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General NPI Number Information
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NPI Number | 1215741525
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Entity Type | Organization
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Legal Business Name | VITAL STEPS RECOVERY
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 300 OLIVE ST STE 507
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City | TEXARKANA
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State | AR
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Zip | 71854-5920
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Country | US
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Telephone | 870-330-0902
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Fax |
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Provider Business Mailing Address
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Address Line | 300 OLIVE ST STE 507
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City | TEXARKANA
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State | AR
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Zip | 71854-5920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CODY PHIPPS
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Credential |
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Telephone | 870-330-0902
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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