Provider Demographics
NPI:1376658070
Name:BAY AREA RECOVERY CENTER
Entity Type:Organization
Organization Name:BAY AREA RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-332-5428
Mailing Address - Street 1:4316 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6641
Mailing Address - Country:US
Mailing Address - Phone:281-957-9201
Mailing Address - Fax:281-957-9195
Practice Address - Street 1:4316 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6641
Practice Address - Country:US
Practice Address - Phone:281-957-9201
Practice Address - Fax:281-957-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X101YA0400X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108120OtherBHIPS ENTITY
TX123079OtherBHIPS ENTITY
TX123053OtherBHIPS ENTITY
TX283930001Medicaid