Provider Demographics
NPI:1639896533
Name:ENSO RECOVERY LLC
Entity Type:Organization
Organization Name:ENSO RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-245-1800
Mailing Address - Street 1:90 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7270
Mailing Address - Country:US
Mailing Address - Phone:207-245-1800
Mailing Address - Fax:
Practice Address - Street 1:90 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7270
Practice Address - Country:US
Practice Address - Phone:207-245-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
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