Provider Demographics
NPI:1417446709
Name:EATING RECOVERY CENTER OF TEXAS
Entity Type:Organization
Organization Name:EATING RECOVERY CENTER OF TEXAS
Other - Org Name:EATING RECOVERY CENTER OF FT. WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-214-9321
Mailing Address - Street 1:7351 E. LOWRY BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230
Mailing Address - Country:US
Mailing Address - Phone:972-476-0800
Mailing Address - Fax:972-985-0403
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:877-825-8584
Practice Address - Fax:972-985-0403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EATING RECOVERY CENTER OF TEXAS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-02
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health