Provider Demographics
NPI:1922041870
Name:ENNEAD ENTERPRISES CORP.
Entity Type:Organization
Organization Name:ENNEAD ENTERPRISES CORP.
Other - Org Name:S.C. PHYSICIANS IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, MEDICAL AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TRABER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:661-255-2880
Mailing Address - Street 1:2426 CAROL PARK PL
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1112
Mailing Address - Country:US
Mailing Address - Phone:661-255-2880
Mailing Address - Fax:661-255-2190
Practice Address - Street 1:23501 CINEMA DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-255-2880
Practice Address - Fax:661-255-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care