MEDICARE: BARRY C EITEL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1134250764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRY C EITEL, INC.

Provider Business Mailing Address
First Line	:	4315 PIEHL RD
Second Line	:
City	:	OTTAWA LAKE
State	:	MI
Zip	:	49267-8710
Country	:	US
Telephone Number	:	419-260-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 PIEHL RD
Second Line	:
City	:	OTTAWA LAKE
State	:	MI
Zip	:	49267-8710
Country	:	US
Telephone Number	:	419-260-5552
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BARRY EITEL SR.
Credential	:	MSW
Telephone Number	:	419-260-5552

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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