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General NPI Number Information
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NPI Number | 1902040082
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Entity Type | Organization
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Legal Business Name | ENHANCED SENIOR LIVING, LLC
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 763 VILLAGE GREEN DR
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City | DESOTO
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State | TX
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Zip | 75115-2209
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Country | US
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Telephone | 972-780-0811
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Fax | 972-780-0811
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Provider Business Mailing Address
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Address Line | 500 QUICK SILVER DR
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City | DESOTO
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State | TX
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Zip | 75115-3680
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Country | US
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Telephone | 972-780-0811
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Fax | 972-780-0811
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. SHIRLEY A. KING
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Credential | PHD
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Telephone | 972-780-0811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | TX
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