Provider Demographics
NPI:1720591647
Name:FAITH RECOVERY TREATMENT CENTER
Entity Type:Organization
Organization Name:FAITH RECOVERY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHANEKIA
Authorized Official - Middle Name:DYSHA
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-520-5237
Mailing Address - Street 1:3024 MAHANNA SPRINGS DRIVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235
Mailing Address - Country:US
Mailing Address - Phone:202-520-5237
Mailing Address - Fax:888-639-9004
Practice Address - Street 1:3024 MAHANNA SPRINGS DR APT D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-8735
Practice Address - Country:US
Practice Address - Phone:202-520-5237
Practice Address - Fax:888-639-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care