Provider Demographics
NPI:1265168942
Name:FLOURISHING FOUNDATIONS RECOVERY, LLC
Entity type:Organization
Organization Name:FLOURISHING FOUNDATIONS RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DI MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-796-1253
Mailing Address - Street 1:11507 MOUNTAIN CLIMB
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3450
Mailing Address - Country:US
Mailing Address - Phone:805-796-1253
Mailing Address - Fax:772-206-3292
Practice Address - Street 1:6707 W HAUSMAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4173
Practice Address - Country:US
Practice Address - Phone:805-796-1253
Practice Address - Fax:210-783-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder