Healthcare Provider Details

I. General information

NPI: 1639896533
Provider Name (Legal Business Name): ENSO RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 WESTERN AVE
AUGUSTA ME
04330-7270
US

IV. Provider business mailing address

90 WESTERN AVE
AUGUSTA ME
04330-7270
US

V. Phone/Fax

Practice location:
  • Phone: 207-245-1800
  • Fax:
Mailing address:
  • Phone: 207-245-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIPAK DATTANI
Title or Position: DIRECTOR
Credential:
Phone: 207-245-1800