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General NPI Number Information
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NPI Number | 1649400508
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Entity Type | Organization
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Legal Business Name | ENHANCED THERAPEUTIC SOLUTIONS, LLC
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 4601A E 10TH ST
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City | GREENVILLE
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State | NC
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Zip | 27858-9414
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Country | US
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Telephone | 252-320-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 2805 MADISON GROVE RD
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City | GREENVILLE
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State | NC
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Zip | 27858-7238
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Country | US
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Telephone | 252-320-3222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA MONIQUE GREEN
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Credential |
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Telephone | 252-320-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training 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 | 251T00000X
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Taxonomy Name | PACE Provider Organization
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider 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 | 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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