Provider Demographics
NPI:1689390155
Name:ENLITE OF CARE NURSE ASSISTANTS
Entity Type:Organization
Organization Name:ENLITE OF CARE NURSE ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:816-715-7032
Mailing Address - Street 1:2300 MAIN ST STE 904
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2416
Mailing Address - Country:US
Mailing Address - Phone:816-438-3131
Mailing Address - Fax:
Practice Address - Street 1:2300 MAIN ST STE 904
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2416
Practice Address - Country:US
Practice Address - Phone:816-438-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care