Healthcare Provider Details

I. General information

NPI: 1073031084
Provider Name (Legal Business Name): SWIFT BEHAVIORAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5895 WALSH PT APT 208
COLORADO SPRINGS CO
80919-2043
US

IV. Provider business mailing address

5895 WALSH PT APT 208
COLORADO SPRINGS CO
80919-2043
US

V. Phone/Fax

Practice location:
  • Phone: 425-246-7038
  • Fax:
Mailing address:
  • Phone: 719-679-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11623142
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIK M EAGLE
Title or Position: OWNER
Credential: BCBA
Phone: 425-246-7038