Provider Demographics
NPI:1124627443
Name:RESURGENCE TEXAS
Entity type:Organization
Organization Name:RESURGENCE TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-244-5481
Mailing Address - Street 1:10703 RANCH ROAD 12
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5239
Mailing Address - Country:US
Mailing Address - Phone:949-244-5481
Mailing Address - Fax:
Practice Address - Street 1:10703 RANCH ROAD 12
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5239
Practice Address - Country:US
Practice Address - Phone:888-700-5053
Practice Address - Fax:949-209-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder