Provider Demographics
NPI:1184680019
Name:ELLIOT BEACH CORP
Entity Type:Organization
Organization Name:ELLIOT BEACH CORP
Other - Org Name:BELTONE HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PREM
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:559-227-9509
Mailing Address - Street 1:4686 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0903
Mailing Address - Country:US
Mailing Address - Phone:559-227-9509
Mailing Address - Fax:559-227-2737
Practice Address - Street 1:4686 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0903
Practice Address - Country:US
Practice Address - Phone:559-227-9509
Practice Address - Fax:559-227-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3899237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty