Provider Demographics
NPI:1174815617
Name:EATIN THERAPEUTIC CENTER
Entity type:Organization
Organization Name:EATIN THERAPEUTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-454-2224
Mailing Address - Street 1:123 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-3425
Mailing Address - Country:US
Mailing Address - Phone:970-454-2224
Mailing Address - Fax:970-454-3147
Practice Address - Street 1:123 ELM AVE
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-3425
Practice Address - Country:US
Practice Address - Phone:970-454-2224
Practice Address - Fax:970-454-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO819320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities