Provider Demographics
NPI:1093382517
Name:ASIC RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:ASIC RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-865-5141
Mailing Address - Street 1:3256 LACKLAND RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5307
Mailing Address - Country:US
Mailing Address - Phone:817-616-0504
Mailing Address - Fax:817-616-0758
Practice Address - Street 1:3256 LACKLAND RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5307
Practice Address - Country:US
Practice Address - Phone:817-616-0504
Practice Address - Fax:817-616-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility