Provider Demographics
NPI:1619740107
Name:ENTERPRISE ALLIANCE GROUP INC
Entity Type:Organization
Organization Name:ENTERPRISE ALLIANCE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-289-0700
Mailing Address - Street 1:333 N BROAD ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3706
Mailing Address - Country:US
Mailing Address - Phone:908-289-0700
Mailing Address - Fax:
Practice Address - Street 1:333 N BROAD ST STE 2B
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3706
Practice Address - Country:US
Practice Address - Phone:908-289-0700
Practice Address - Fax:908-289-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health