Healthcare Provider Details

I. General information

NPI: 1033975149
Provider Name (Legal Business Name): ENLIGHTENMENT TRANSITIONAL LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 TOURNAMENT DR STE 150
MEMPHIS TN
38125-8900
US

IV. Provider business mailing address

8295 TOURNAMENT DR STE 150
MEMPHIS TN
38125-8900
US

V. Phone/Fax

Practice location:
  • Phone: 901-356-8075
  • Fax:
Mailing address:
  • Phone: 901-356-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHERAKA JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 901-857-1193