1972560365 NPI number — ENS HEALTH CARE MANAGEMENT LLC

Table of content: (NPI 1972560365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972560365 NPI number — ENS HEALTH CARE MANAGEMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENS HEALTH CARE MANAGEMENT LLC
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:
INTERIM HEALTHCARE OF THE CAPITAL REGION
Provider Other Organization Name Type Code:
3
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:
1972560365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1735 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12205-4758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-452-3655
Provider Business Mailing Address Fax Number:
518-452-0765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1735 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12205-4758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-452-3655
Provider Business Practice Location Address Fax Number:
518-452-0765
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CO-PRESIDENT
Authorized Official Telephone Number:
518-452-3655

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1063L001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: 1063L002 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 1063L003 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02200360 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02861741 . This is a "TBI PROGRAM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1063L003 . This is a "SARATOGA LICENSE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02150443 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063L002 . This is a "GLENS FALLS LICENSE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1063L001 . This is a "LHCSA LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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