Provider Demographics
NPI:1992168983
Name:ASCENSION EASTWOOD BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:ASCENSION EASTWOOD BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:
Practice Address - Street 1:2800 LIVERNOIS RD STE 500
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1219
Practice Address - Country:US
Practice Address - Phone:586-753-0400
Practice Address - Fax:586-753-0404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTWOOD COMMUNITY CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-29
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101Y00000X, 101YA0400X, 103T00000X, 104100000X, 106H00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396787701Medicare PIN