Healthcare Provider Details

I. General information

NPI: 1528268018
Provider Name (Legal Business Name): ENHANCE LIVING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 VISTA RUN
SAN ANTONIO TX
78247-4684
US

IV. Provider business mailing address

835 PROTON RD
SAN ANTONIO TX
78258-4203
US

V. Phone/Fax

Practice location:
  • Phone: 210-558-3097
  • Fax: 210-558-9791
Mailing address:
  • Phone: 210-558-3097
  • Fax: 210-558-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: MIKE HAWKER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 210-340-7155