Provider Demographics
NPI:1679948764
Name:TEXAN RESORT RECOVERY LLC
Entity type:Organization
Organization Name:TEXAN RESORT RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-533-8714
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:860 CO RD 142
Mailing Address - City:LAKE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81235-0156
Mailing Address - Country:US
Mailing Address - Phone:970-944-2246
Mailing Address - Fax:970-944-2477
Practice Address - Street 1:860 CO RD 142
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:CO
Practice Address - Zip Code:81235
Practice Address - Country:US
Practice Address - Phone:970-944-2246
Practice Address - Fax:970-944-2477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARBROVITAE ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility