Healthcare Provider Details

I. General information

NPI: 1205367901
Provider Name (Legal Business Name): EATING RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE STE 1900
CHICAGO IL
60601-3994
US

IV. Provider business mailing address

333 N MICHIGAN AVE STE 1900
CHICAGO IL
60601-3994
US

V. Phone/Fax

Practice location:
  • Phone: 773-321-2750
  • Fax:
Mailing address:
  • Phone: 773-321-2750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LAURA LANGE
Title or Position: DIRECTOR
Credential: LCSW
Phone: 847-650-4751