Provider Demographics
NPI:1932329166
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:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-680-8121
Mailing Address - Street 1:PO BOX 19117
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4086
Mailing Address - Country:US
Mailing Address - Phone:248-680-8000
Mailing Address - Fax:586-680-8030
Practice Address - Street 1:22151 MORROS, PB1
Practice Address - Street 2:SUITE 334
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2114
Practice Address - Country:US
Practice Address - Phone:313-343-7230
Practice Address - Fax:313-343-7449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTWOOD COMMUNITY CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-30
Last Update Date:2023-11-15
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
MI20468OtherBCBSMI SA NUMBER