Provider Demographics
NPI:1083422299
Name:HD ENTERPRISE LLC
Entity type:Organization
Organization Name:HD ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDEGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-751-3924
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-0009
Mailing Address - Country:US
Mailing Address - Phone:937-751-3924
Mailing Address - Fax:
Practice Address - Street 1:732 EUCLID COURT
Practice Address - Street 2:SUITE L3
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044
Practice Address - Country:US
Practice Address - Phone:937-751-3924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)