Provider Demographics
NPI:1265022040
Name:ENHANCING LIVES IN THE COMMUNITY, LLC
Entity Type:Organization
Organization Name:ENHANCING LIVES IN THE COMMUNITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERNESSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG-REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:190-466-9715
Mailing Address - Street 1:793 BLANDING BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5792
Mailing Address - Country:US
Mailing Address - Phone:904-466-9715
Mailing Address - Fax:
Practice Address - Street 1:793 BLANDING BLVD STE H
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5792
Practice Address - Country:US
Practice Address - Phone:190-466-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services