Provider Demographics
NPI:1770027567
Name:EATING RECOVERY CENTER
Entity Type:Organization
Organization Name:EATING RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIRCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:630-291-5107
Mailing Address - Street 1:3121 W AUGUSTA BLVD
Mailing Address - Street 2:APT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4315
Mailing Address - Country:US
Mailing Address - Phone:630-291-5107
Mailing Address - Fax:
Practice Address - Street 1:3121 AUGUSTA BLVD
Practice Address - Street 2:APT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:630-291-5107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1035415261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service