Provider Demographics
NPI:1548420524
Name:LIFE ENHANCEMENT SERVICES OF LOUISIANA INC
Entity Type:Organization
Organization Name:LIFE ENHANCEMENT SERVICES OF LOUISIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERB
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:704-560-4332
Mailing Address - Street 1:230 S TRYON ST UNIT 1010
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3260
Mailing Address - Country:US
Mailing Address - Phone:704-560-4332
Mailing Address - Fax:704-342-9584
Practice Address - Street 1:3677 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3843
Practice Address - Country:US
Practice Address - Phone:704-516-6046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health