Provider Demographics
NPI:1770210064
Name:LUNA RECOVERY SERVICES, LLC
Entity type:Organization
Organization Name:LUNA RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-850-2980
Mailing Address - Street 1:5757 WOODWAY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-1506
Mailing Address - Country:US
Mailing Address - Phone:832-930-4863
Mailing Address - Fax:
Practice Address - Street 1:5757 WOODWAY DR STE 176
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1521
Practice Address - Country:US
Practice Address - Phone:832-930-4863
Practice Address - Fax:832-850-2981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUNA RECOVERY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health