Provider Demographics
NPI:1336891704
Name:ENHANCED LIFESTYLE SENIOR HEALTHCARE LLC
Entity Type:Organization
Organization Name:ENHANCED LIFESTYLE SENIOR HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-453-6179
Mailing Address - Street 1:2125 HARDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5918
Mailing Address - Country:US
Mailing Address - Phone:863-838-8114
Mailing Address - Fax:863-345-8793
Practice Address - Street 1:2125 HARDEN BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5918
Practice Address - Country:US
Practice Address - Phone:863-838-8114
Practice Address - Fax:863-345-8793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty