Provider Demographics
NPI:1508950007
Name:ADDICTION TREATMENT CENTER OF LONGMONT
Entity Type:Organization
Organization Name:ADDICTION TREATMENT CENTER OF LONGMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:EISERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-651-9282
Mailing Address - Street 1:2130 MOUNTAIN VIEW AVENUE
Mailing Address - Street 2:A-2
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-651-9200
Mailing Address - Fax:
Practice Address - Street 1:2130 MOUNTAIN VIEW AVENUE
Practice Address - Street 2:SUITE A-2
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-651-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1311-00101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty