Healthcare Provider Details

I. General information

NPI: 1982871380
Provider Name (Legal Business Name): EATON THERAPEUTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 ELM AVE
EATON CO
80615-3425
US

IV. Provider business mailing address

123 ELM AVE
EATON CO
80615-3425
US

V. Phone/Fax

Practice location:
  • Phone: 970-454-2224
  • Fax: 970-454-3147
Mailing address:
  • Phone: 970-454-2224
  • Fax: 970-454-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number14277290000
License Number StateCO

VIII. Authorized Official

Name: MRS. DOROTHY ARLEEN MONGAN
Title or Position: MASSAGE THERAPIST
Credential: C.M.T.
Phone: 970-454-2224