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NPI Code Detail

MEDICARE: TAOS RECOVERY, INC.

MEDICARE: TAOS 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
1324500000XSubstance Abuse Rehabilitation Facility5633NM

General Provider Information

NPI Number : 1790791697
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAOS RECOVERY, INC.
Provider Business Mailing Address
First Line : 235 W HICKORY ST STE 201
Second Line :
City : DENTON
State : TX
Zip : 76201-4122
Country : US
Telephone Number : 940-383-2843
Fax Number :
Provider Business Practice Location Address
First Line : 259 BLUEBERRY HILL RD
Second Line :
City : EL PRADO
State : NM
Zip : 87529-7305
Country : US
Telephone Number : 575-758-5858
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. BLAKE BROWDER
Credential :
Telephone Number : 575-758-5858
Provider Enumeration Date : 07/31/2006
Last Update Date : 05/02/2019

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