Provider Demographics
NPI:1386230258
Name:SEACREST RECOVERY CENTER HOUSTON, LLC
Entity Type:Organization
Organization Name:SEACREST RECOVERY CENTER HOUSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-411-8019
Mailing Address - Street 1:638 E OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5005
Mailing Address - Country:US
Mailing Address - Phone:800-411-8019
Mailing Address - Fax:
Practice Address - Street 1:10696 HADDINGTON DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-3247
Practice Address - Country:US
Practice Address - Phone:800-411-8019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4617OtherSTATE LICENSE