Provider Demographics
NPI:1871044867
Name:EATING RECOVERY CENTER OF WASHINGTON
Entity type:Organization
Organization Name:EATING RECOVERY CENTER OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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 1:1601 114TH AVE SE
Mailing Address - Street 2:SUITE #180
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6950
Mailing Address - Country:US
Mailing Address - Phone:425-451-1134
Mailing Address - Fax:
Practice Address - Street 1:1601 114TH AVE SE
Practice Address - Street 2:SUITE #180
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6950
Practice Address - Country:US
Practice Address - Phone:425-451-1134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EATING RECOVERY CENTER OF WA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty