Provider Demographics
NPI:1598327405
Name:ELIMINATING BARRIERS & CONQUERING GOALS LLC
Entity Type:Organization
Organization Name:ELIMINATING BARRIERS & CONQUERING GOALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEMICAL DEPENDENCY COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:FOX-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC II, OCPS
Authorized Official - Phone:937-815-9035
Mailing Address - Street 1:4825 HASSAN CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-1315
Mailing Address - Country:US
Mailing Address - Phone:937-815-9035
Mailing Address - Fax:
Practice Address - Street 1:4825 HASSAN CIR APT 2
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-1315
Practice Address - Country:US
Practice Address - Phone:937-815-9035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility