1871910109 NPI number — CENTER FOR EATING DISORDERS & PSYCHOTHERAPY

Table of content: (NPI 1871910109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871910109 NPI number — CENTER FOR EATING DISORDERS & PSYCHOTHERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR EATING DISORDERS & PSYCHOTHERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871910109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1295 BANDANA BLVD. W.
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-364-5977
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 E GRANVILLE RD
Provider Second Line Business Practice Location Address:
BUILDING N
Provider Business Practice Location Address City Name:
WORTHINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43085-3192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-364-5977
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
NORRIS
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL COUNSEL
Authorized Official Telephone Number:
866-364-5977

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  7125 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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