Provider Demographics
NPI:1821291584
Name:BEACH HEALTH CLINIC,INC.
Entity Type:Organization
Organization Name:BEACH HEALTH CLINIC,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-428-5601
Mailing Address - Street 1:3396 HOLLAND RD STE 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4824
Mailing Address - Country:US
Mailing Address - Phone:757-428-5601
Mailing Address - Fax:757-428-7872
Practice Address - Street 1:3396 HOLLAND RD STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4824
Practice Address - Country:US
Practice Address - Phone:757-428-5601
Practice Address - Fax:757-428-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201004157261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center