MEDICARE: ENTERLOCK CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1376117267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTERLOCK CORP

Provider Business Mailing Address
First Line	:	675 DEIS DR # 218
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-8136
Country	:	US
Telephone Number	:	513-200-9029
Fax Number	:	800-385-6901

Provider Business Practice Location Address
First Line	:	5956 SUNRIDGE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-4521
Country	:	US
Telephone Number	:	513-200-9029
Fax Number	:	800-385-6901

Authorized Official
Title or Position	:	COORDINATOR
Name	:	MS. DIANN DILLINGHAM
Credential	:
Telephone Number	:	513-200-9029

Provider Enumeration Date	:	05/17/2021
Last Update Date	:	05/17/2021

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Directions to “ENTERLOCK CORP ” Practice Location

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