Provider Demographics
NPI:1275389611
Name:ENGEDI
Entity Type:Organization
Organization Name:ENGEDI
Other - Org Name:ENVAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-686-8293
Mailing Address - Street 1:868 HARCOURT RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1834
Mailing Address - Country:US
Mailing Address - Phone:740-398-5316
Mailing Address - Fax:
Practice Address - Street 1:868 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1834
Practice Address - Country:US
Practice Address - Phone:740-398-5316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty