BLUE HERON RECOVERY LLC NPI 1861098188

NPI Information

NPI: 1861098188
Provider Name: BLUE HERON RECOVERY LLC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 45D2218579

Address:
2015 NE LOOP 410
SAN ANTONIO, TX
ZIP 78217
Phone: (210) 291-6426
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BLUE HERON RECOVERY LLC is a rehabilitation and substance use disorder clinic center in San Antonio, TX. BLUE HERON RECOVERY LLC NPI is 1861098188. The provider is registered as an organization entity type.

The provider's business location address is:

2015 NE LOOP 410
SAN ANTONIO, TX
ZIP 78217-411
Phone: (210) 291-6426

The provider's authorized official is Christine M Varela Mayer .
The authorized official title is Ceo and has the following contact phone number (210) 291-6426.

The CLIA number assigned to this NPI record is 45D2218579 - other - outpt substance abuse tx with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/10/2020 and was last updated on 12/10/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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