Provider Demographics
NPI:1639786445
Name:EATING RECOVERY CENTER
Entity Type:Organization
Organization Name:EATING RECOVERY CENTER
Other - Org Name:
Other - Org Type:
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:206-383-4781
Mailing Address - Street 1:PO BOX 56181
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256
Mailing Address - Country:US
Mailing Address - Phone:303-825-8584
Mailing Address - Fax:303-825-8587
Practice Address - Street 1:8140 E. 5TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230
Practice Address - Country:US
Practice Address - Phone:877-825-8584
Practice Address - Fax:303-731-8144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EATING RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty