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	251B00000X	Case Management Agency
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720324312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLORS ENHANCED LIVING III INC

Provider Business Mailing Address
First Line	:	105 HOLLY HILL DR STE A
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2556
Country	:	US
Telephone Number	:	804-733-8847
Fax Number	:	804-732-4963

Provider Business Practice Location Address
First Line	:	589 S CRATER RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-5263
Country	:	US
Telephone Number	:	804-733-4114
Fax Number	:

Authorized Official
Title or Position	:	EXE DIR
Name	:	MRS. DENISE TAYLOR
Credential	:
Telephone Number	:	804-586-6937

Provider Enumeration Date	:	12/31/2012
Last Update Date	:	02/18/2026

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