Provider Demographics
NPI:1821586959
Name:ACORN HILL EAAT, INC.
Entity Type:Organization
Organization Name:ACORN HILL EAAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, TRI
Authorized Official - Phone:540-454-1711
Mailing Address - Street 1:7969 65TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MOTLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56466-2238
Mailing Address - Country:US
Mailing Address - Phone:540-454-1711
Mailing Address - Fax:
Practice Address - Street 1:7969 65TH AVE SW
Practice Address - Street 2:
Practice Address - City:MOTLEY
Practice Address - State:MN
Practice Address - Zip Code:56466-2238
Practice Address - Country:US
Practice Address - Phone:540-454-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center