Provider Demographics
NPI:1932322856
Name:LIFE ENHANCEMENT SERVICES
Entity Type:Organization
Organization Name:LIFE ENHANCEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERB
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-956-7176
Mailing Address - Street 1:411 W CHAPEL HILL ST
Mailing Address - Street 2:SUITE 902
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3616
Mailing Address - Country:US
Mailing Address - Phone:919-956-7176
Mailing Address - Fax:919-682-2339
Practice Address - Street 1:665 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-5017
Practice Address - Country:US
Practice Address - Phone:336-882-2122
Practice Address - Fax:336-882-8508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management