Provider Demographics
NPI:1780892612
Name:A CENTER FOR LIFE ENHANCEMENT, INC.
Entity type:Organization
Organization Name:A CENTER FOR LIFE ENHANCEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:H
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, LCPC
Authorized Official - Phone:207-625-4525
Mailing Address - Street 1:100 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CORNISH
Mailing Address - State:ME
Mailing Address - Zip Code:04020-3115
Mailing Address - Country:US
Mailing Address - Phone:207-625-4525
Mailing Address - Fax:
Practice Address - Street 1:100 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CORNISH
Practice Address - State:ME
Practice Address - Zip Code:04020-3115
Practice Address - Country:US
Practice Address - Phone:207-625-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP277235Z00000X
MECC953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131380099Medicaid
ME131370100Medicaid