Provider Demographics
NPI:1679118863
Name:MIDDLETON, ERIC L
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SEARCY DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-4840
Mailing Address - Country:US
Mailing Address - Phone:254-563-7919
Mailing Address - Fax:
Practice Address - Street 1:1701 LENNOX AVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-2147
Practice Address - Country:US
Practice Address - Phone:254-563-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251C00000XAgenciesDay Training, Developmentally Disabled Services