Mallard Lake Ranch Detox Center, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

MALLARD LAKE RANCH DETOX CENTER, LLC

Practice address

18407 Hopfe Rd.
Hockley, TX 77447-7119

Phone

(936) 800-8025

Fax

(281) 781-2526

NPI assigned

Feb 8, 2021

Last updated

Feb 22, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kristi Taylor

Title

Ceo/Owner

Phone

(713) 444-0614

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jessica Fuentes, APRN-CNP

  • Family Nurse Practitioner
  • Hockley, TX
  • NPI 1407780562
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1265024566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1104",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773471104",
            "telephone_number": "713-444-0614",
            "fax_number": "281-781-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18407 HOPFE RD.",
            "city": "HOCKLEY",
            "state": "TX",
            "postal_code": "774477119",
            "telephone_number": "936-800-8025",
            "fax_number": "281-781-2526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLARD LAKE RANCH DETOX CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-08",
        "last_updated": "2024-02-22",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "713-444-0614"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Land
• Latitude 47 LLC (Cowboy Up Therapies)
• Giavana Ariel Lima
• Ross Little, MAT, LAT, ATC
• Lone Star Home Care Group LLC
• Maripoza Group LLC
• Sara Katherine McDugle
• Benjamin Paul Minter I, RPSGT
• Elizabeth Monterrosas
• Kieshanda Monet Morgan, LCSW

• Substance Abuse Rehabilitation Facility in Hockley, TX
• Providers in Hockley, TX by specialty
• Substance Abuse Rehabilitation Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.