Organization
ENRICHING HOME CARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEJYANA CLARK (OWNER)
(763) 232-4946
Entity
Organization
Contact information
Practice address
6045 VICKSBURG LN N, PLYMOUTH, MN 55446-1140
(763) 232-4946
(763) 325-9602
Mailing address
6045 VICKSBURG LN N, PLYMOUTH, MN 55446-1140
(763) 232-4946
(763) 325-9602
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437872413
—
MN
Enumeration date
05/28/2024
Last updated
06/04/2024
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