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General NPI Number Information
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NPI Number | 1770027567
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Entity Type | Organization
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Legal Business Name | EATING RECOVERY CENTER
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 3121 AUGUSTA BLVD APT 3
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City | CHICAGO
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State | IL
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Zip | 60622
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Country | US
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Telephone | 630-291-5107
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Fax |
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Provider Business Mailing Address
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Address Line | 3121 W AUGUSTA BLVD APT 3
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City | CHICAGO
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State | IL
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Zip | 60622-4315
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Country | US
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Telephone | 630-291-5107
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MS. LINDSAY M BIRCHFIELD
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Credential | RD
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Telephone | 630-291-5107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1035415
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License Number State | NY
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