Provider Demographics
NPI:1205135290
Name:TRIANGLE SPECIALIZED HEALTH CARE BUSINESS ENTERPRISE CORPORATION
Entity type:Organization
Organization Name:TRIANGLE SPECIALIZED HEALTH CARE BUSINESS ENTERPRISE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EFEHI
Authorized Official - Middle Name:HENRIETTA
Authorized Official - Last Name:ENOBAKHARE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:817-422-6925
Mailing Address - Street 1:1013 CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1245
Mailing Address - Country:US
Mailing Address - Phone:956-561-1461
Mailing Address - Fax:956-267-5255
Practice Address - Street 1:1805 RUBEN M TORRES BLVD
Practice Address - Street 2:SUITE A 3
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-561-1461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396073599OtherNPPES
TX384660201Medicaid