Healthcare Provider Details

I. General information

NPI: 1811513278
Provider Name (Legal Business Name): MANIGAULT ENTERPRISE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 WOODTOP WAY
BEL AIR MD
21015-6370
US

IV. Provider business mailing address

2103 WOODTOP WAY
BEL AIR MD
21015-6370
US

V. Phone/Fax

Practice location:
  • Phone: 410-905-8150
  • Fax:
Mailing address:
  • Phone: 410-905-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMANTHA MARIE MANIGAULT
Title or Position: CEO,PARTNER/OPERATIONS MANAGER
Credential: MS, BS
Phone: 410-905-8150