Provider Demographics
NPI:1194469296
Name:AVA RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:AVA RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT-S, LCDC
Authorized Official - Phone:325-267-0608
Mailing Address - Street 1:815 ELLIOTT RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-9334
Mailing Address - Country:US
Mailing Address - Phone:833-330-3009
Mailing Address - Fax:
Practice Address - Street 1:815 ELLIOTT RANCH RD
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-9334
Practice Address - Country:US
Practice Address - Phone:833-330-3009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility