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General NPI Number Information
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NPI Number | 1548903552
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Entity Type | Organization
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Legal Business Name | ENRICHING LIVES SUPPORT SERVICES INC
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 911 W 36TH ST STE 2&7
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City | BALTIMORE
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State | MD
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Zip | 21211-2445
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Country | US
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Telephone | 443-322-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 911 W 36TH ST STE 2&7
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City | BALTIMORE
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State | MD
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Zip | 21211-2445
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Country | US
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Telephone | 443-322-5777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAQUISA NASH
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Credential |
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Telephone | 443-722-6116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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