Provider Demographics
NPI:1699390195
Name:LIFE ENHANCEMENT HOME CARE LLC
Entity Type:Organization
Organization Name:LIFE ENHANCEMENT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-907-7462
Mailing Address - Street 1:121 S ELM ST STE 1-A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2601
Mailing Address - Country:US
Mailing Address - Phone:336-907-7462
Mailing Address - Fax:336-763-0233
Practice Address - Street 1:121 S ELM ST STE 1-A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2601
Practice Address - Country:US
Practice Address - Phone:336-405-9177
Practice Address - Fax:844-785-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC5526Medicaid