Provider Demographics
NPI:1255043840
Name:AGENCY FOR TREATMENT ENRICHMENT & REHABILITATION LLC
Entity type:Organization
Organization Name:AGENCY FOR TREATMENT ENRICHMENT & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TI ONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-956-6330
Mailing Address - Street 1:1940 FOUNTAIN VIEW DR # 1133
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3206
Mailing Address - Country:US
Mailing Address - Phone:877-763-5473
Mailing Address - Fax:
Practice Address - Street 1:5850 SAN FELIPE ST STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-8003
Practice Address - Country:US
Practice Address - Phone:877-763-5473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty