Healthcare Provider Details

I. General information

NPI: 1346062155
Provider Name (Legal Business Name): ENOVED CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HWY STE 205
WALDORF MD
20601-2816
US

IV. Provider business mailing address

2670 CRAIN HWY STE 205
WALDORF MD
20601-2816
US

V. Phone/Fax

Practice location:
  • Phone: 301-363-4900
  • Fax:
Mailing address:
  • Phone: 301-363-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DEVONE CLARICE WILLIAMS
Title or Position: CEO
Credential:
Phone: 240-417-0586