Provider Demographics
NPI:1114743481
Name:COMMUNITY ENHANCE LIVING SOLUTION LLC
Entity type:Organization
Organization Name:COMMUNITY ENHANCE LIVING SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:OWOSENI
Authorized Official - Middle Name:E
Authorized Official - Last Name:OMOWAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-264-5602
Mailing Address - Street 1:455 SHASTA ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5109
Mailing Address - Country:US
Mailing Address - Phone:603-264-8236
Mailing Address - Fax:
Practice Address - Street 1:455 SHASTA ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5109
Practice Address - Country:US
Practice Address - Phone:603-264-8236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities