Healthcare Provider Details

I. General information

NPI: 1609639624
Provider Name (Legal Business Name): ENABLEHEALTH ALLIANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6198 MURRAY TER
FREDERICK MD
21703-2895
US

IV. Provider business mailing address

6198 MURRAY TER
FREDERICK MD
21703-2895
US

V. Phone/Fax

Practice location:
  • Phone: 917-972-3223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EYRAM ATTIKPO
Title or Position: ADMINISTRATOR
Credential:
Phone: 917-972-3223