Provider Demographics
NPI:1730309964
Name:ASCENSION EASTWOOD BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ASCENSION EASTWOOD BEHAVIORAL HEALTH
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 1:1460 WALTON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:248-844-6234
Practice Address - Fax:248-844-6237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTWOOD COMMUNITY CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-30
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20441OtherBCBSMI SA NUMBER