Provider Demographics
NPI:1659645786
Name:LIFE ENHANCEMENT SERVICES, LCL
Entity Type:Organization
Organization Name:LIFE ENHANCEMENT SERVICES, LCL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HERB
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-342-9595
Mailing Address - Street 1:500 E MOREHEAD ST
Mailing Address - Street 2:STE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2616
Mailing Address - Country:US
Mailing Address - Phone:704-342-9595
Mailing Address - Fax:
Practice Address - Street 1:500 E MOREHEAD ST
Practice Address - Street 2:STE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2616
Practice Address - Country:US
Practice Address - Phone:704-342-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health