Provider Demographics
NPI:1003689936
Name:AWAKENINGS HILL COUNTRY LLC
Entity Type:Organization
Organization Name:AWAKENINGS HILL COUNTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UTILIZATION REVIEW DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-302-2922
Mailing Address - Street 1:184 FULLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-8313
Mailing Address - Country:US
Mailing Address - Phone:830-302-2922
Mailing Address - Fax:830-326-6660
Practice Address - Street 1:203 JEFFERSON
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-302-2922
Practice Address - Fax:830-326-6660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AWAKENINGS HILL COUNTRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-02
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health