Provider Demographics
NPI:1033759915
Name:ACUNA COMMUNITY PROVIDERS
Entity Type:Organization
Organization Name:ACUNA COMMUNITY PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-470-8767
Mailing Address - Street 1:3404 93RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-3640
Mailing Address - Country:US
Mailing Address - Phone:806-470-8767
Mailing Address - Fax:
Practice Address - Street 1:3404 93RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-3640
Practice Address - Country:US
Practice Address - Phone:806-470-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities