Provider Demographics
NPI:1396574786
Name:LIFE ENRICHMENT SERVICES LLC
Entity type:Organization
Organization Name:LIFE ENRICHMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:JACKS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:907-830-1455
Mailing Address - Street 1:8330 ARLENE ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4615
Mailing Address - Country:US
Mailing Address - Phone:907-830-1455
Mailing Address - Fax:907-258-0444
Practice Address - Street 1:8330 ARLENE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4615
Practice Address - Country:US
Practice Address - Phone:907-830-1455
Practice Address - Fax:907-258-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty