Provider Demographics
NPI:1962163709
Name:COMPLETE CARE AND RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:COMPLETE CARE AND RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:817-584-9368
Mailing Address - Street 1:1131 PARKVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5841
Mailing Address - Country:US
Mailing Address - Phone:817-584-9368
Mailing Address - Fax:
Practice Address - Street 1:5625 GOOD SHEPHERD WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-4233
Practice Address - Country:US
Practice Address - Phone:817-480-7599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty