Provider Demographics
NPI:1639840432
Name:REGALADO RECOVERY AND SELF DISCOVERY INC
Entity Type:Organization
Organization Name:REGALADO RECOVERY AND SELF DISCOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGALADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-923-5573
Mailing Address - Street 1:3700 MOUNT WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-3250
Mailing Address - Country:US
Mailing Address - Phone:214-923-5573
Mailing Address - Fax:
Practice Address - Street 1:3700 MOUNT WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-3250
Practice Address - Country:US
Practice Address - Phone:214-923-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health