Provider Demographics
NPI:1366736167
Name:ENGAGE ENTERPRISES, LLC
Entity type:Organization
Organization Name:ENGAGE ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHROPSHIRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-507-6622
Mailing Address - Street 1:100 EAGLES WALK
Mailing Address - Street 2:SUITE D
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6335
Mailing Address - Country:US
Mailing Address - Phone:770-507-6622
Mailing Address - Fax:404-591-5132
Practice Address - Street 1:100 EAGLES WALK STE D
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6335
Practice Address - Country:US
Practice Address - Phone:770-507-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-0295253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care