MEDICARE: KAREN DIANE ECCLES

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	320800000X	Mental Illness Community Based Residential Treatment Facility	GF-467290	NV
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	GF-467290	NV
3	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	GF-467290	NV
4	323P00000X	Psychiatric Residential Treatment Facility	GF-467290	NV
5	324500000X	Substance Abuse Rehabilitation Facility	GF-467290	NV
6	385H00000X	Respite Care	GF-467290	NV

General Provider Information

NPI Number	:	1508046699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN DIANE ECCLES

Provider Business Mailing Address
First Line	:	18252 OAKBROOK LN
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89508-4020
Country	:	US
Telephone Number	:	775-624-2882
Fax Number	:	775-624-2882

Provider Business Practice Location Address
First Line	:	18252 OAKBROOK LN
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89508-4020
Country	:	US
Telephone Number	:	775-624-2882
Fax Number	:	775-624-2882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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Directions to “ KAREN DIANE ECCLES ” Practice Location

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