Provider Demographics
NPI:1720324312
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:EXE DIR
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:804-586-1587
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 1:589 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5263
Practice Address - Country:US
Practice Address - Phone:804-733-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty