Provider Demographics
NPI:1598963597
Name:E.C.I.,INC
Entity Type:Organization
Organization Name:E.C.I.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-443-0767
Mailing Address - Street 1:382 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1841
Mailing Address - Country:US
Mailing Address - Phone:419-443-0767
Mailing Address - Fax:419-443-1018
Practice Address - Street 1:382 S HURON ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1841
Practice Address - Country:US
Practice Address - Phone:419-443-0767
Practice Address - Fax:419-443-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7400146Medicaid