Provider Demographics
NPI:1851649099
Name:SOUTHWEST HEALTHCARE VENTURES
Entity Type:Organization
Organization Name:SOUTHWEST HEALTHCARE VENTURES
Other - Org Name:CAMBIO LIFE RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:972-754-6257
Mailing Address - Street 1:5509 RUSTIC TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3218
Mailing Address - Country:US
Mailing Address - Phone:972-754-6257
Mailing Address - Fax:
Practice Address - Street 1:1903 DOCTORS HOSPITAL DR STE 1
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2276
Practice Address - Country:US
Practice Address - Phone:972-754-6257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility