Provider Demographics
NPI:1073999678
Name:AWAKENINGS HILL COUNTRY LLC
Entity Type:Organization
Organization Name:AWAKENINGS HILL COUNTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRODY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-669-7976
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:806-669-7976
Mailing Address - Fax:806-688-9214
Practice Address - Street 1:184 FULLBROOK LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-8313
Practice Address - Country:US
Practice Address - Phone:806-669-7976
Practice Address - Fax:806-688-9214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility