MEDICARE: ENHANCED LIVING DESIGN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	B874609	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B874609	OTHER	CA	CONTRACTOR LICENSE

General Provider Information

NPI Number	:	1376730598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENHANCED LIVING DESIGN

Provider Business Mailing Address
First Line	:	27 SPECTRUM POINTE DR
Second Line	:	SUITE 306
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-2273
Country	:	US
Telephone Number	:	800-598-9181
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 SPECTRUM POINTE DR
Second Line	:	SUITE 306
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-2273
Country	:	US
Telephone Number	:	800-598-9181
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DON WOODS
Credential	:	B874609
Telephone Number	:	800-598-9181

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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