Healthcare Provider Details

I. General information

NPI: 1144152760
Provider Name (Legal Business Name): EQUINOX ECLIPSE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 WINDING WAY
SAN CARLOS CA
94070-2820
US

IV. Provider business mailing address

412 WINDING WAY
SAN CARLOS CA
94070-2820
US

V. Phone/Fax

Practice location:
  • Phone: 650-771-7862
  • Fax:
Mailing address:
  • Phone: 650-771-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BILLIE JEAN BENSON
Title or Position: DIRECTOR
Credential: CMPSS
Phone: 650-771-7862