Provider Demographics
NPI:1578768776
Name:GROTH RECOVERY ALLIANCE
Entity Type:Organization
Organization Name:GROTH RECOVERY ALLIANCE
Other - Org Name:THE SOAR PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-265-5900
Mailing Address - Street 1:3525 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1225
Mailing Address - Country:US
Mailing Address - Phone:214-265-5900
Mailing Address - Fax:214-265-9766
Practice Address - Street 1:466 COUNTY ROAD 2119
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-3686
Practice Address - Country:US
Practice Address - Phone:903-855-0330
Practice Address - Fax:903-855-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2522-A3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children