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General NPI Number Information
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NPI Number | 1508950007
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Entity Type | Organization
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Legal Business Name | ADDICTION TREATMENT CENTER OF LONGMONT
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2130 MOUNTAIN VIEW AVENUE SUITE A-2
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City | LONGMONT
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State | CO
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Zip | 80501
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Country | US
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Telephone | 303-651-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 MOUNTAIN VIEW AVENUE A-2
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City | LONGMONT
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State | CO
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Zip | 80501
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Country | US
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Telephone | 303-651-9200
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROBERT HENRY EISERMAN
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Credential |
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Telephone | 303-651-9282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1311-00
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License Number State | CO
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