Provider Demographics
NPI:1629148960
Name:CENTER FOR LIFE ENHANCEMENT LLC
Entity Type:Organization
Organization Name:CENTER FOR LIFE ENHANCEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, CCM
Authorized Official - Phone:321-698-3594
Mailing Address - Street 1:21 W FEE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-951-3949
Mailing Address - Fax:321-951-3987
Practice Address - Street 1:21 W FEE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-951-3949
Practice Address - Fax:321-951-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW65641041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty