Basic Information
| Provider Information | |||||||||
| NPI: | 1972626380 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENKI HEALTH & RESEARCH SYSTEMS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALPINE COUNTY BEHAVIORAL HEALTH SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 E OLIVE AVE | ||||||||
| Address2: | STE. 203 | ||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915021846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189734899 | ||||||||
| FaxNumber: | 8189734888 | ||||||||
| Practice Location | |||||||||
| Address1: | 75C DIAMOND VALLEY ROAD | ||||||||
| Address2: | |||||||||
| City: | MARKLEEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306941816 | ||||||||
| FaxNumber: | 5306942387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 03/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | URMER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT-C.O.O. | ||||||||
| AuthorizedOfficialTelephone: | 8189734899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.H.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 000000215 | 05 | CA | MEDICAID |