Healthcare Provider Details

I. General information

NPI: 1033890736
Provider Name (Legal Business Name): ENOCH MEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 AILSA AVE
BALTIMORE MD
21214-2521
US

IV. Provider business mailing address

2818 AILSA AVE
BALTIMORE MD
21214-2521
US

V. Phone/Fax

Practice location:
  • Phone: 443-525-7546
  • Fax:
Mailing address:
  • Phone: 443-525-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: REGINA FLUCAS
Title or Position: OWNER
Credential:
Phone: 443-525-7546