Provider Demographics
NPI:1063767242
Name:ENRICHED HEALTH SERVICES INC
Entity type:Organization
Organization Name:ENRICHED HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:252-317-2006
Mailing Address - Street 1:1100 HARDEE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-2529
Mailing Address - Country:US
Mailing Address - Phone:252-347-2711
Mailing Address - Fax:252-294-1137
Practice Address - Street 1:1100 HARDEE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-2529
Practice Address - Country:US
Practice Address - Phone:252-347-2711
Practice Address - Fax:252-294-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC888465251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health