Healthcare Provider Details

I. General information

NPI: 1134535131
Provider Name (Legal Business Name): ENACT LEARNING TECHNOLOGIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 TRAILS END RD
WILMINGTON NC
28409-3546
US

IV. Provider business mailing address

PO BOX 15581
WILMINGTON NC
28408-5581
US

V. Phone/Fax

Practice location:
  • Phone: 828-773-0217
  • Fax:
Mailing address:
  • Phone: 828-773-0217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN CALLAHAN
Title or Position: PRESIDENT/CEO
Credential: MPA
Phone: 828-773-0217