Provider Demographics
NPI:1851603708
Name:ORIGINS RECOVERY OF TEXAS LLC
Entity Type:Organization
Organization Name:ORIGINS RECOVERY OF TEXAS LLC
Other - Org Name:ORIGINS RECOVERY CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-283-8500
Mailing Address - Street 1:4001 MAPLE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3241
Mailing Address - Country:US
Mailing Address - Phone:214-817-4964
Mailing Address - Fax:
Practice Address - Street 1:4610 PADRE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH PADRE ISLAND
Practice Address - State:TX
Practice Address - Zip Code:78597-7327
Practice Address - Country:US
Practice Address - Phone:956-772-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3318-3319324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility