Provider Demographics
NPI:1659814192
Name:EATING RECOVERY CENTER
Entity type:Organization
Organization Name:EATING RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY THERAPIST II
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-964-4617
Mailing Address - Street 1:2300 N LINCOLN PARK W
Mailing Address - Street 2:UNIT 1212
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3456
Mailing Address - Country:US
Mailing Address - Phone:630-649-8772
Mailing Address - Fax:
Practice Address - Street 1:150 E HURON ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2999
Practice Address - Country:US
Practice Address - Phone:312-964-4617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201543752320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness