1245361948 NPI number — ENKI HEALTH SERVICES, INC.

Table of content: (NPI 1245361948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245361948 NPI number — ENKI HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENKI HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ENKI ELAMHS-BELL GARDENS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245361948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 E OLIVE AVE
Provider Second Line Business Mailing Address:
#203
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91502-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-973-4899
Provider Business Mailing Address Fax Number:
818-973-4888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 CLARA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELL GARDENS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-806-5000
Provider Business Practice Location Address Fax Number:
562-806-9395
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
URMER
Authorized Official First Name:
CARL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT, C.O.O
Authorized Official Telephone Number:
818-973-4899

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000007254 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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