Basic Information
| Provider Information | |||||||||
| NPI: | 1851585806 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ENA, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NECCO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 11490 SPRINGFIELD PIKE | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452463524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137719600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11490 SPRINGFIELD PIKE | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452463524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137719600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 09/04/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCHREIBER | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DEVELOPMENT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9193238080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.