Provider Demographics
NPI:1619415213
Name:INFINITE RECOVERY LLC
Entity Type:Organization
Organization Name:INFINITE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:603-781-4629
Mailing Address - Street 1:7517 CAMERON RD STE 118
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752
Mailing Address - Country:US
Mailing Address - Phone:512-975-2658
Mailing Address - Fax:
Practice Address - Street 1:7517 CAMERON RD STE #118
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752
Practice Address - Country:US
Practice Address - Phone:512-975-2658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3767-3768324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility