Provider Demographics
NPI:1386823185
Name:LIFE ENRICHMENT SERVICES
Entity Type:Organization
Organization Name:LIFE ENRICHMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-339-8300
Mailing Address - Street 1:9100 BAPTIST CAMPGROUND RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-8075
Mailing Address - Country:US
Mailing Address - Phone:205-242-3577
Mailing Address - Fax:
Practice Address - Street 1:9100 BAPTIST CAMPGROUND RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-8075
Practice Address - Country:US
Practice Address - Phone:205-242-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALG8357354H320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities