Healthcare Provider Details

I. General information

NPI: 1467212076
Provider Name (Legal Business Name): ECC CREATIVE SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 REDWOOD AVE
BOULDER CO
80304-1115
US

IV. Provider business mailing address

1515 REDWOOD AVE
BOULDER CO
80304-1115
US

V. Phone/Fax

Practice location:
  • Phone: 303-842-1441
  • Fax:
Mailing address:
  • Phone: 303-842-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EILEEN GALLAGHER
Title or Position: CEO, OWNER
Credential: MD
Phone: 303-842-1441