Provider Demographics
NPI:1306888631
Name:HEALTH ENTERPRISES
Entity type:Organization
Organization Name:HEALTH ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENZENBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-883-0288
Mailing Address - Street 1:22573 BARTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5203
Mailing Address - Country:US
Mailing Address - Phone:909-883-0288
Mailing Address - Fax:888-836-9159
Practice Address - Street 1:22573 BARTON RD STE B
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5203
Practice Address - Country:US
Practice Address - Phone:909-883-0288
Practice Address - Fax:909-883-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000615251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57680GMedicaid
CA557680Medicare ID - Type Unspecified