Healthcare Provider Details

I. General information

NPI: 1336044544
Provider Name (Legal Business Name): ENRICHED LIVING FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 PROFESSIONAL PKWY E STE 200
LAKEWOOD RANCH FL
34240-8473
US

IV. Provider business mailing address

6901 PROFESSIONAL PKWY STE 200
LAKEWOOD RANCH FL
34240-8473
US

V. Phone/Fax

Practice location:
  • Phone: 651-505-6766
  • Fax:
Mailing address:
  • Phone: 651-505-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: RIC NELSON
Title or Position: CEO
Credential:
Phone: 651-259-8607