Provider Demographics
NPI:1881149425
Name:MARTIN'S RECOVERY CENTER
Entity type:Organization
Organization Name:MARTIN'S RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:817-717-4983
Mailing Address - Street 1:1456 SIERRA SPRINGS DR
Mailing Address - Street 2:APT 811
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-7646
Mailing Address - Country:US
Mailing Address - Phone:817-717-4983
Mailing Address - Fax:
Practice Address - Street 1:1456 SIERRA SPRINGS DR
Practice Address - Street 2:APT 811
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-7646
Practice Address - Country:US
Practice Address - Phone:817-717-4983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13296251B00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty