Provider Demographics
NPI:1366812877
Name:DAILEY RECOVERY SERVICE
Entity type:Organization
Organization Name:DAILEY RECOVERY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:806-471-3249
Mailing Address - Street 1:PO BOX 33046
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79120-3046
Mailing Address - Country:US
Mailing Address - Phone:806-471-3249
Mailing Address - Fax:877-339-0645
Practice Address - Street 1:2430 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6612
Practice Address - Country:US
Practice Address - Phone:806-471-3249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3883-3884251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1972987741Medicaid