Provider Demographics
NPI:1457302002
Name:ENCOMPASS CARE COMPANY INC
Entity Type:Organization
Organization Name:ENCOMPASS CARE COMPANY INC
Other - Org Name:ZION HEALING CENTER JACKSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:BERGUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-769-2707
Mailing Address - Street 1:6 BLACKSTONE VALLEY PL STE 301
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1112
Mailing Address - Country:US
Mailing Address - Phone:508-769-2707
Mailing Address - Fax:401-305-3028
Practice Address - Street 1:6 BLACKSTONE VALLEY PL STE 301
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1112
Practice Address - Country:US
Practice Address - Phone:508-769-2707
Practice Address - Fax:401-305-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21827Medicare ID - Type Unspecified