Provider Demographics
NPI:1346062155
Name:ENOVED CO
Entity type:Organization
Organization Name:ENOVED CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVONE
Authorized Official - Middle Name:CLARICE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-417-0586
Mailing Address - Street 1:2670 CRAIN HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2816
Mailing Address - Country:US
Mailing Address - Phone:301-363-4900
Mailing Address - Fax:
Practice Address - Street 1:2670 CRAIN HWY STE 205
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2816
Practice Address - Country:US
Practice Address - Phone:301-363-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty