Provider Demographics
NPI:1063834166
Name:ALIVE AND WELL RECOVERY CENTER
Entity Type:Organization
Organization Name:ALIVE AND WELL RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:FRONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PRSS
Authorized Official - Phone:817-944-7871
Mailing Address - Street 1:204 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7034
Mailing Address - Country:US
Mailing Address - Phone:817-944-7871
Mailing Address - Fax:
Practice Address - Street 1:204 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7034
Practice Address - Country:US
Practice Address - Phone:817-944-7871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health