Provider Demographics
NPI:1134163967
Name:ENUDA HEALTHSOURCE, INC.
Entity type:Organization
Organization Name:ENUDA HEALTHSOURCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KALU
Authorized Official - Middle Name:ORJI
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-787-9294
Mailing Address - Street 1:5106 OAK PARK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3017
Mailing Address - Country:US
Mailing Address - Phone:919-787-9294
Mailing Address - Fax:
Practice Address - Street 1:5106 OAK PARK RD
Practice Address - Street 2:SUITE A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3017
Practice Address - Country:US
Practice Address - Phone:919-787-9294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00836332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704211Medicaid
5019890002Medicare NSC