MEDICARE: 1 STOP RECOVERY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	2142-2142	TX

General Provider Information

NPI Number	:	1316309339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1 STOP RECOVERY, INC.

Provider Business Mailing Address
First Line	:	4141 NORTH FWY
Second Line	:	STE. 310
City	:	HOUSTON
State	:	TX
Zip	:	77022-4208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 NORTH FWY
Second Line	:	STE. 310
City	:	HOUSTON
State	:	TX
Zip	:	77022-4208
Country	:	US
Telephone Number	:	713-697-9820
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	RHONDA PATRICK
Credential	:	LCSW
Telephone Number	:	713-397-9098

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	03/29/2016

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