Healthcare Provider Details

I. General information

NPI: 1740702166
Provider Name (Legal Business Name): ENHANCING LIFE SENIOR DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 TIDEWATER TRL
FREDERICKSBURG VA
22408-2050
US

IV. Provider business mailing address

10721 TIDEWATER TRL
FREDERICKSBURG VA
22408-2050
US

V. Phone/Fax

Practice location:
  • Phone: 540-693-1331
  • Fax:
Mailing address:
  • Phone: 540-693-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1103755
License Number StateVA

VIII. Authorized Official

Name: MR. ERIC WARD
Title or Position: DIRECTOR
Credential:
Phone: 540-710-3397