Provider Demographics
NPI:1366981557
Name:ENHANCE HEALTH CARE SERVICES BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:ENHANCE HEALTH CARE SERVICES BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-450-3216
Mailing Address - Street 1:1058 E WORTHY ST STE B-2
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4359
Mailing Address - Country:US
Mailing Address - Phone:225-450-3216
Mailing Address - Fax:225-450-3799
Practice Address - Street 1:1058 E WORTHY ST STE B-2
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4359
Practice Address - Country:US
Practice Address - Phone:225-450-3216
Practice Address - Fax:225-450-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
LA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2546937Medicaid