Healthcare Provider Details

I. General information

NPI: 1922609734
Provider Name (Legal Business Name): ENSOR HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12140 MURRAY AVE
LARGO FL
33778-2421
US

IV. Provider business mailing address

13494 WALSINGHAM RD
LARGO FL
33774-3527
US

V. Phone/Fax

Practice location:
  • Phone: 272-867-7716
  • Fax: 727-286-8542
Mailing address:
  • Phone: 727-735-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE F ENSOR
Title or Position: REGISTERED NURSE
Credential:
Phone: 727-735-1317