MEDICARE: TAYLORS ENHANCED LIVING III INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1255677845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLORS ENHANCED LIVING III INC

Provider Business Mailing Address
First Line	:	1617 BOULEVARD
Second Line	:	SUITE D
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2329
Country	:	US
Telephone Number	:	804-733-8847
Fax Number	:

Provider Business Practice Location Address
First Line	:	3267 S CRATER RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9216
Country	:	US
Telephone Number	:	804-504-0056
Fax Number	:

Authorized Official
Title or Position	:	EXE DIR
Name	:	LAWRENCE STARKE
Credential	:	LPC
Telephone Number	:	804-586-1587

Provider Enumeration Date	:	12/31/2012
Last Update Date	:	12/31/2012

Similar Medicare Providers

1245750488 — PHOENIX N PEACE LLC
Practice Location Address:

3297C S CRATER RD
PETERSBURG, VA
23805-9216

Practice Phone: 804-862-8810
Practice Fax:

1497514368 — 3 DIMENSIONS COUNSELING SERVICES, LLC
Practice Location Address:

3287 S CRATER RD
PETERSBURG, VA
23805-9216

Practice Phone: 804-835-4242
Practice Fax: 804-324-5487

1700857836 — DR. HALUK K AYDIN MD
Practice Location Address:

269 MEDICAL PARK BLVD
PETERSBURG, VA
23805-9337

Practice Phone: 804-861-0700
Practice Fax: 804-863-4626

1861354797 — SUSAN SPENCER COVINGTON PMHNP
Practice Location Address:

200 MEDICAL PARK BLVD
PETERSBURG, VA
23805-9274

Practice Phone: 804-467-8719
Practice Fax:

1174992382 — MELISSA DALTON WAGNER APRN
Practice Location Address:

34 MEDICAL PARK BLVD
PETERSBURG, VA
23805-9283

Practice Phone: 804-609-0175
Practice Fax: 804-835-5999

1851254098 — M & M BEHAVIORAL HEALTH SERVICES, LLC
Practice Location Address:

1879 S SYCAMORE ST
PETERSBURG, VA
23805-2730

Practice Phone: 804-926-9372
Practice Fax:

Directions to “TAYLORS ENHANCED LIVING III INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.