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General NPI Number Information
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NPI Number | 1700744661
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Entity Type | Organization
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Legal Business Name | ILLUMINATE MY PATH RECOVERY HOMES, LLC
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 517 GRISTMILL LN
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City | EVERMAN
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State | TX
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Zip | 76140-4709
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Country | US
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Telephone | 214-429-4920
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Fax |
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Provider Business Mailing Address
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Address Line | 517 GRISTMILL LN
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City | EVERMAN
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State | TX
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Zip | 76140-4709
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Country | US
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Telephone | 214-429-4020
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | LISA LEE
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Credential |
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Telephone | 817-999-9945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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