Provider Demographics
NPI:1790791697
Name:TAOS RECOVERY, INC.
Entity Type:Organization
Organization Name:TAOS RECOVERY, INC.
Other - Org Name:VISTA TAOS RENEWAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-758-5858
Mailing Address - Street 1:235 W HICKORY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4122
Mailing Address - Country:US
Mailing Address - Phone:940-383-2843
Mailing Address - Fax:
Practice Address - Street 1:259 BLUEBERRY HILL RD
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-7305
Practice Address - Country:US
Practice Address - Phone:575-758-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5633324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility