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General NPI Number Information
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NPI Number | 1821586959
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Entity Type | Organization
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Legal Business Name | ACORN HILL EAAT, INC.
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 7969 65TH AVE SW
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City | MOTLEY
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State | MN
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Zip | 56466-2238
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Country | US
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Telephone | 540-454-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 7969 65TH AVE SW
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City | MOTLEY
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State | MN
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Zip | 56466-2238
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Country | US
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Telephone | 540-454-1711
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Fax |
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Authorized Official
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Title or Position | FOUNDER/EXECUTIVE DIRECTOR
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Name | KELLY PETERSON
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Credential | M.ED., TRI
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Telephone | 540-454-1711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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