Provider Demographics
NPI:1063207892
Name:ENCHANTED IMPRESSIONS
Entity type:Organization
Organization Name:ENCHANTED IMPRESSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYANA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:WHITING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-634-0236
Mailing Address - Street 1:440 DIETZ ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2328
Mailing Address - Country:US
Mailing Address - Phone:973-634-0236
Mailing Address - Fax:
Practice Address - Street 1:440 DIETZ ST
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2328
Practice Address - Country:US
Practice Address - Phone:973-634-0236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-11
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child