Provider Demographics
NPI:1700522315
Name:ECLECTIC HEALTH PC
Entity Type:Organization
Organization Name:ECLECTIC HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BEAUBIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-561-9337
Mailing Address - Street 1:811 SOUTH BLVD E STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5359
Mailing Address - Country:US
Mailing Address - Phone:248-561-9337
Mailing Address - Fax:
Practice Address - Street 1:811 SOUTH BLVD E STE 110
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5359
Practice Address - Country:US
Practice Address - Phone:248-561-9337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service