Provider Demographics
NPI:1063537850
Name:ECLECTIC NATUROPATHIC MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:ECLECTIC NATUROPATHIC MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-665-1254
Mailing Address - Street 1:2434 BERLIN TURNPIKE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-665-1254
Mailing Address - Fax:860-665-7135
Practice Address - Street 1:2434 BERLIN TPKE
Practice Address - Street 2:SUITE 18
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4121
Practice Address - Country:US
Practice Address - Phone:860-665-1254
Practice Address - Fax:860-665-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000079175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty