Provider Demographics
NPI:1770721813
Name:ENRICHMENT FOR LIFE, INC.
Entity type:Organization
Organization Name:ENRICHMENT FOR LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:919-345-5847
Mailing Address - Street 1:4501 NEW BERN AVE
Mailing Address - Street 2:SUITE 130-120
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1549
Mailing Address - Country:US
Mailing Address - Phone:919-349-4206
Mailing Address - Fax:
Practice Address - Street 1:1138 DREW ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2702
Practice Address - Country:US
Practice Address - Phone:919-667-1580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-470320900000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities