Healthcare Provider Details

I. General information

NPI: 1033056619
Provider Name (Legal Business Name): YAHUAHS ESSENCE ENRICHMENTCOMMUNITY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 RICH DR
PALM SPRINGS FL
33406-6565
US

IV. Provider business mailing address

613 RICH DR
PALM SPRINGS FL
33406-6565
US

V. Phone/Fax

Practice location:
  • Phone: 561-820-7646
  • Fax: 561-820-7646
Mailing address:
  • Phone: 561-820-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MATTIE LINCOLN
Title or Position: PRESIDENT
Credential:
Phone: 561-820-7646