Healthcare Provider Details

I. General information

NPI: 1902952229
Provider Name (Legal Business Name): TAYLORS ENHANCED LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 BERKELEY AVE
PETERSBURG VA
23805-2806
US

IV. Provider business mailing address

1655 E TUCKAHOE ST
PETERSBURG VA
23805-1429
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-5944
  • Fax: 804-520-8575
Mailing address:
  • Phone: 804-520-5944
  • Fax: 804-520-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number839
License Number StateVA

VIII. Authorized Official

Name: MRS. DENISE DANIELS TAYLOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 804-520-5944