Provider Demographics
NPI:1023386398
Name:EASTWOOD COMMUNITY CLINICS
Entity Type:Organization
Organization Name:EASTWOOD COMMUNITY CLINICS
Other - Org Name:EASTWOOD CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-753-0400
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-0400
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:45660 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-6033
Practice Address - Country:US
Practice Address - Phone:586-566-3020
Practice Address - Fax:586-566-3055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTWOOD COMMUNITY CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI500457101Y00000X, 103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty