Provider Demographics
NPI:1821254053
Name:LIFE ENHANCEMENT SERVICES, INC.
Entity Type:Organization
Organization Name:LIFE ENHANCEMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRIUS
Authorized Official - Middle Name:JERMAINE
Authorized Official - Last Name:CRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-299-2821
Mailing Address - Street 1:108 EASTSIDE ST
Mailing Address - Street 2:103
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-1701
Mailing Address - Country:US
Mailing Address - Phone:334-727-1122
Mailing Address - Fax:334-727-7277
Practice Address - Street 1:108 EASTSIDE ST.
Practice Address - Street 2:103
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-1701
Practice Address - Country:US
Practice Address - Phone:334-727-1122
Practice Address - Fax:334-727-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management