Provider Demographics
NPI:1326554882
Name:ENLIGHTENED SOLUTIONS DETOX LLC
Entity Type:Organization
Organization Name:ENLIGHTENED SOLUTIONS DETOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-270-4006
Mailing Address - Street 1:1501 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-1209
Mailing Address - Country:US
Mailing Address - Phone:609-270-4006
Mailing Address - Fax:
Practice Address - Street 1:1501 N ALBANY AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-1209
Practice Address - Country:US
Practice Address - Phone:609-270-4006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility