Provider Demographics
NPI:1174670210
Name:ENNEAD ENTERPRISES CORP
Entity Type:Organization
Organization Name:ENNEAD ENTERPRISES CORP
Other - Org Name:SC PHYSICIANS IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-255-2880
Mailing Address - Street 1:26012 OHARA LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1109
Mailing Address - Country:US
Mailing Address - Phone:661-255-6920
Mailing Address - Fax:
Practice Address - Street 1:23501 CINEMA DR.
Practice Address - Street 2:SUIRE #100
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-255-2880
Practice Address - Fax:661-255-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52007261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care