Provider Demographics
NPI:1609639624
Name:ENABLEHEALTH ALLIANCE INC
Entity Type:Organization
Organization Name:ENABLEHEALTH ALLIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EYRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTIKPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-972-3223
Mailing Address - Street 1:6198 MURRAY TER
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2895
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6198 MURRAY TER
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2895
Practice Address - Country:US
Practice Address - Phone:917-972-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty