Healthcare Provider Details

I. General information

NPI: 1306888631
Provider Name (Legal Business Name): HEALTH ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22573 BARTON RD STE B
GRAND TERRACE CA
92313-5203
US

IV. Provider business mailing address

22573 BARTON RD STE B
GRAND TERRACE CA
92313-5203
US

V. Phone/Fax

Practice location:
  • Phone: 909-883-0288
  • Fax: 909-883-5088
Mailing address:
  • Phone: 909-883-0288
  • Fax: 888-836-9159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number240000615
License Number StateCA

VIII. Authorized Official

Name: JOE ENZENBACHER
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 909-883-0288