Provider Demographics
NPI:1376820209
Name:ENLIVEN RESOURCES, LLC
Entity Type:Organization
Organization Name:ENLIVEN RESOURCES, LLC
Other - Org Name:ENLIVEN RESOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, SAP
Authorized Official - Phone:614-940-4868
Mailing Address - Street 1:929 HARRISON AVE
Mailing Address - Street 2:304
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1346
Mailing Address - Country:US
Mailing Address - Phone:614-940-4868
Mailing Address - Fax:614-923-7525
Practice Address - Street 1:929 HARRISON AVE
Practice Address - Street 2:304
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1346
Practice Address - Country:US
Practice Address - Phone:614-940-4868
Practice Address - Fax:614-923-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-06
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700102-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty