Provider Demographics
NPI:1578344933
Name:CHARIS KAI ELEOS LLC
Entity Type:Organization
Organization Name:CHARIS KAI ELEOS LLC
Other - Org Name:CHARIS KAI ELEOS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:517-836-2178
Mailing Address - Street 1:2487 S MICHIGAN RD STE E
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-8252
Mailing Address - Country:US
Mailing Address - Phone:517-836-2178
Mailing Address - Fax:517-836-2182
Practice Address - Street 1:2487 S MICHIGAN RD STE E
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-8252
Practice Address - Country:US
Practice Address - Phone:517-836-2178
Practice Address - Fax:517-836-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty