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General NPI Number Information
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NPI Number | 1033975149
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Entity Type | Organization
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Legal Business Name | ENLIGHTENMENT TRANSITIONAL LIVING LLC
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 8295 TOURNAMENT DR STE 150
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City | MEMPHIS
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State | TN
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Zip | 38125-8900
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Country | US
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Telephone | 901-356-8075
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Fax |
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Provider Business Mailing Address
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Address Line | 8295 TOURNAMENT DR STE 150
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City | MEMPHIS
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State | TN
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Zip | 38125-8900
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Country | US
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Telephone | 901-356-8075
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHERAKA JOHNSON
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Credential |
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Telephone | 901-857-1193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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