Provider Demographics
NPI:1477175842
Name:DOMINION RECOVERY MANAGERS LLC
Entity type:Organization
Organization Name:DOMINION RECOVERY MANAGERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-915-0642
Mailing Address - Street 1:9002 CHIMNEY ROCK RD STE G238
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2509
Mailing Address - Country:US
Mailing Address - Phone:832-915-0642
Mailing Address - Fax:832-209-8011
Practice Address - Street 1:7211 REGENCY SQUARE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3137
Practice Address - Country:US
Practice Address - Phone:832-915-0642
Practice Address - Fax:832-209-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No251B00000XAgenciesCase Management