Provider Demographics
NPI:1972155422
Name:CONGENIAL HEALTHCARE, LLC
Entity type:Organization
Organization Name:CONGENIAL HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ENDERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-712-1681
Mailing Address - Street 1:1 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2200
Mailing Address - Country:US
Mailing Address - Phone:978-536-0215
Mailing Address - Fax:978-536-0230
Practice Address - Street 1:255 GRAPEVINE RD
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984
Practice Address - Country:US
Practice Address - Phone:978-536-0215
Practice Address - Fax:978-536-0230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONGENIAL HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-15
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health