Healthcare Provider Details

I. General information

NPI: 1649141250
Provider Name (Legal Business Name): ENJOYABLE LIFE ADULT FAMILY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 ELLINGTON AVE SE
PALM BAY FL
32909-4121
US

IV. Provider business mailing address

424 ELLINGTON AVE SE
PALM BAY FL
32909-4121
US

V. Phone/Fax

Practice location:
  • Phone: 321-458-0054
  • Fax: 321-327-7610
Mailing address:
  • Phone: 321-458-0054
  • Fax: 321-327-7610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JEAN EDDY DUCASSE
Title or Position: OWNER
Credential:
Phone: 321-458-0054