Provider Demographics
| NPI: | 1871107185 |
|---|---|
| Name: | LIFE GIVING LIFE THE RECOVERY PROJECT |
| Entity type: | Organization |
| Organization Name: | LIFE GIVING LIFE THE RECOVERY PROJECT |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PEER SPECIALIST |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JAMIE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MCKIBBEN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | CASE MANAGER |
| Authorized Official - Phone: | 512-662-9041 |
| Mailing Address - Street 1: | 222 N VERSHIRE CIR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MAGNOLIA |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 77354-3309 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 512-662-9041 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 14740 LIBERTY ST. |
| Practice Address - Street 2: | |
| Practice Address - City: | MONTGOMERY |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77354-7735 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 512-662-9041 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-09-03 |
| Last Update Date: | 2020-09-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
| No | 251B00000X | Agencies | Case Management | |
| No | 251E00000X | Agencies | Home Health | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
| No | 261QR0800X | Ambulatory Health Care Facilities | Clinic/Center | Recovery Care |
| No | 276400000X | Hospital Units | Rehabilitation, Substance Use Disorder Unit | |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
