MEDICARE: TRI-COUNTY RECOVERY CENTER A TEXAS NON-PROFIT CORPORATION

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	3137-3140	TX
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	3137-3138	TX

General Provider Information

NPI Number	:	1386958734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-COUNTY RECOVERY CENTER A TEXAS NON-PROFIT CORPORATION

Provider Business Mailing Address
First Line	:	2107 N MAYS ST
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2155
Country	:	US
Telephone Number	:	512-828-0800
Fax Number	:	512-828-0947

Provider Business Practice Location Address
First Line	:	2107 N MAYS ST
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2155
Country	:	US
Telephone Number	:	512-828-0800
Fax Number	:	512-828-0947

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JOANNE K HOOVER
Credential	:
Telephone Number	:	512-828-0800

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	07/28/2010

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