Provider Demographics
NPI:1063994044
Name:NAMASTE RECOVERY MANAGEMENT LLC
Entity type:Organization
Organization Name:NAMASTE RECOVERY MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RECOVERY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:719-553-7929
Mailing Address - Street 1:912 GLENDA DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7019
Mailing Address - Country:US
Mailing Address - Phone:719-553-7929
Mailing Address - Fax:
Practice Address - Street 1:912 GLENDA DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-7019
Practice Address - Country:US
Practice Address - Phone:719-553-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care