Healthcare Provider Details

I. General information

NPI: 1639001969
Provider Name (Legal Business Name): MS. EDEN EISENBEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HOLLY RD STE 3
GRAND BLANC MI
48439-1978
US

IV. Provider business mailing address

5220 ROLLING HILLS DR
GRAND BLANC MI
48439-9045
US

V. Phone/Fax

Practice location:
  • Phone: 810-348-5928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: