Provider Demographics
NPI:1720713779
Name:EISELE ENTERPRISES, LLC
Entity Type:Organization
Organization Name:EISELE ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE AND DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EISELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-340-6014
Mailing Address - Street 1:1727 WESTERN RUN RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1122
Mailing Address - Country:US
Mailing Address - Phone:410-340-6014
Mailing Address - Fax:
Practice Address - Street 1:1300 YORK RD BLDG A
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6016
Practice Address - Country:US
Practice Address - Phone:410-340-6014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty