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General NPI Number Information
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NPI Number | 1730530155
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Entity Type | Organization
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Legal Business Name | LUNA RECOVERY SERVICES, LLC
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 5757 WOODWAY DR SUITE 110
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City | HOUSTON
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State | TX
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Zip | 77057-1514
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Country | US
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Telephone | 888-448-5862
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Fax |
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Provider Business Mailing Address
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Address Line | 5757 WOODWAY DR SUITE 110
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City | HOUSTON
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State | TX
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Zip | 77057-1514
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Country | US
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Telephone | 888-448-5862
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT W PARK
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Credential | LCDC
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Telephone | 832-785-9663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 4070-4071
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License Number State | TX
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