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General NPI Number Information
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NPI Number | 1174815617
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Entity Type | Organization
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Legal Business Name | EATIN THERAPEUTIC CENTER
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 123 ELM AVE
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City | EATON
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State | CO
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Zip | 80615-3425
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Country | US
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Telephone | 970-454-2224
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Fax | 970-454-3147
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Provider Business Mailing Address
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Address Line | 123 ELM AVE
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City | EATON
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State | CO
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Zip | 80615-3425
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Country | US
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Telephone | 970-454-2224
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Fax | 970-454-3147
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DOROTHY MONGAN
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Credential |
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Telephone | 970-454-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 819
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License Number State | CO
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