Provider Demographics
NPI:1801415450
Name:TRAUMA RECOVERY INSTITUTE PA
Entity Type:Organization
Organization Name:TRAUMA RECOVERY INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:KANDYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:512-669-2272
Mailing Address - Street 1:700 MARKET ST STE 105
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2684
Mailing Address - Country:US
Mailing Address - Phone:737-228-0538
Mailing Address - Fax:727-210-7093
Practice Address - Street 1:700 MARKET ST STE 105
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2684
Practice Address - Country:US
Practice Address - Phone:737-228-0538
Practice Address - Fax:737-210-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility