Provider Demographics
NPI:1730652751
Name:NORTH WEST FRONTIER RECOVERY PLLC
Entity Type:Organization
Organization Name:NORTH WEST FRONTIER RECOVERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIOJAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:972-408-3134
Mailing Address - Street 1:225 METRO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-9103
Mailing Address - Country:US
Mailing Address - Phone:972-408-3134
Mailing Address - Fax:972-408-3166
Practice Address - Street 1:225 METRO DR STE 100
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-9103
Practice Address - Country:US
Practice Address - Phone:972-408-3134
Practice Address - Fax:972-408-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone