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General NPI Number Information
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NPI Number | 1578768776
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Entity Type | Organization
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Legal Business Name | GROTH RECOVERY ALLIANCE
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 466 COUNTY ROAD 2119
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City | PITTSBURG
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State | TX
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Zip | 75686-3686
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Country | US
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Telephone | 903-855-0330
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Fax | 903-855-0573
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Provider Business Mailing Address
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Address Line | 3525 ROSEDALE AVE
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City | DALLAS
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State | TX
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Zip | 75205-1225
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Country | US
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Telephone | 214-265-5900
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Fax | 214-265-9766
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MELISSA B GROTH
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Credential |
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Telephone | 214-265-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 2522-A
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License Number State | TX
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