Provider Demographics
NPI:1912370248
Name:LIFEFORCE RECOVERY
Entity Type:Organization
Organization Name:LIFEFORCE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJAT
Authorized Official - Middle Name:
Authorized Official - Last Name:QUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-314-7687
Mailing Address - Street 1:4100 E PIEDRAS DR
Mailing Address - Street 2:SUITE 262
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1401
Mailing Address - Country:US
Mailing Address - Phone:210-314-7687
Mailing Address - Fax:210-314-7494
Practice Address - Street 1:4100 E PIEDRAS DR
Practice Address - Street 2:SUITE 262
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1401
Practice Address - Country:US
Practice Address - Phone:210-314-7687
Practice Address - Fax:210-314-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67102324500000X
3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children