Provider Demographics
NPI:1427657642
Name:RECOVERY RANGER CORPS
Entity type:Organization
Organization Name:RECOVERY RANGER CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANAWITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-683-3131
Mailing Address - Street 1:3426 SHORESIDE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1964
Mailing Address - Country:US
Mailing Address - Phone:210-683-3131
Mailing Address - Fax:
Practice Address - Street 1:3426 SHORESIDE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1964
Practice Address - Country:US
Practice Address - Phone:210-683-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA8467929Medicaid