Provider Demographics
NPI:1053693820
Name:SERVICE ORGANIZATION BENEFITING RECOVERY
Entity type:Organization
Organization Name:SERVICE ORGANIZATION BENEFITING RECOVERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CATES
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:713-459-9427
Mailing Address - Street 1:9337B KATY FWY # 289
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1515
Mailing Address - Country:US
Mailing Address - Phone:713-270-6753
Mailing Address - Fax:
Practice Address - Street 1:12955 MEMORIAL DR STE F225
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-7302
Practice Address - Country:US
Practice Address - Phone:713-270-6753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3354-3355101YA0400X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty