Provider Demographics
NPI:1659767168
Name:ENOC MADERO
Entity Type:Organization
Organization Name:ENOC MADERO
Other - Org Name:OUR KIDS, NUESTROS NINOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ENOC
Authorized Official - Middle Name:E
Authorized Official - Last Name:MADERO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ITFS
Authorized Official - Phone:919-593-7602
Mailing Address - Street 1:6036 BRAMBLEBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6618
Mailing Address - Country:US
Mailing Address - Phone:919-593-7602
Mailing Address - Fax:
Practice Address - Street 1:6036 BRAMBLEBERRY WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6618
Practice Address - Country:US
Practice Address - Phone:919-593-7602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty