Provider Demographics
NPI:1437826286
Name:ENHANCE PSYCHIATRIC ADVANCED NURSING SERVICES INC
Entity Type:Organization
Organization Name:ENHANCE PSYCHIATRIC ADVANCED NURSING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:650-274-4324
Mailing Address - Street 1:17846 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-9521
Mailing Address - Country:US
Mailing Address - Phone:650-274-4324
Mailing Address - Fax:866-380-0676
Practice Address - Street 1:17846 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-9521
Practice Address - Country:US
Practice Address - Phone:866-931-2587
Practice Address - Fax:866-380-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477167666Medicaid