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General NPI Number Information
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NPI Number | 1982487708
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Entity Type | Organization
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Legal Business Name | ENTC LLC
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 1813 AMBAS DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-7445
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Country | US
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Telephone | 928-566-2488
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Fax |
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Provider Business Mailing Address
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Address Line | 55 LAKE HAVASU AVENUE, SUITE F BOX 856
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403
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Country | US
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Telephone | 928-566-2488
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Fax | 928-955-8440
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELA FOLTZ
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Credential |
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Telephone | 928-566-2488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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