Basic Information
| Provider Information | |||||||||
| NPI: | 1861523540 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ENKI HEALTH SERVICES, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ENKI-ELAMHS - COMMERCE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 E OLIVE AVE | ||||||||
| Address2: | #203 | ||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915021846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189734899 | ||||||||
| FaxNumber: | 8189734888 | ||||||||
| Practice Location | |||||||||
| Address1: | 1436 GOODRICH BLVD | ||||||||
| Address2: | |||||||||
| City: | CITY OF COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900225111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237251337 | ||||||||
| FaxNumber: | 3232785344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 06/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | URMER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, C.O.O | ||||||||
| AuthorizedOfficialTelephone: | 8189734899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.H.S. | ||||||||
| NPICertificationDate: | 06/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 000007253 | 05 | CA | MEDICAID |