Healthcare Provider Details

I. General information

NPI: 1639786445
Provider Name (Legal Business Name): EATING RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 E. 5TH AVE
DENVER CO
80230
US

IV. Provider business mailing address

PO BOX 56181
DENVER CO
80256
US

V. Phone/Fax

Practice location:
  • Phone: 877-825-8584
  • Fax: 303-731-8144
Mailing address:
  • Phone: 303-825-8584
  • Fax: 303-825-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARINA SHEPEL
Title or Position: CONTRACTING & CREDENTIALING MANAGER
Credential:
Phone: 206-383-4781