Provider Demographics
NPI:1740460997
Name:ENHANCED HEALTH SERVICES
Entity type:Organization
Organization Name:ENHANCED HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP, ADMINISTRATOR
Authorized Official - Phone:719-260-0616
Mailing Address - Street 1:4445 NORTHPARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4221
Mailing Address - Country:US
Mailing Address - Phone:719-260-0616
Mailing Address - Fax:719-260-1116
Practice Address - Street 1:4445 NORTHPARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4221
Practice Address - Country:US
Practice Address - Phone:719-260-0616
Practice Address - Fax:719-260-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29383013Medicaid