Provider Demographics
NPI:1346486719
Name:TAYLORS ENHANCED LIVING III INC
Entity Type:Organization
Organization Name:TAYLORS ENHANCED LIVING III INC
Other - Org Name:TAYLOR-STARKEWOOD ENTERPRISES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:STARKE
Authorized Official - Suffix:II
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-733-8847
Mailing Address - Street 1:1617 BOULEVARD
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2329
Mailing Address - Country:US
Mailing Address - Phone:804-733-8847
Mailing Address - Fax:804-732-4963
Practice Address - Street 1:1617 BOULEVARD
Practice Address - Street 2:SUITE D
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2329
Practice Address - Country:US
Practice Address - Phone:804-733-8847
Practice Address - Fax:804-732-4963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLORS ENHANCED LIVING INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-06
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services