Provider Demographics
NPI:1942829734
Name:ENHANCING THE QUALITY OF LIFE, LLC
Entity type:Organization
Organization Name:ENHANCING THE QUALITY OF LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERMELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:SUPPORT COORDINATOR
Authorized Official - Phone:803-318-2052
Mailing Address - Street 1:4298 GREAT EGRET WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8760
Mailing Address - Country:US
Mailing Address - Phone:803-318-2052
Mailing Address - Fax:904-203-7302
Practice Address - Street 1:4298 GREAT EGRET WAY
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8760
Practice Address - Country:US
Practice Address - Phone:803-318-2052
Practice Address - Fax:904-203-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty