Healthcare Provider Details

I. General information

NPI: 1548420524
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES OF LOUISIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3677 FLORIDA BLVD
BATON ROUGE LA
70806-3843
US

IV. Provider business mailing address

230 S TRYON ST UNIT 1010
CHARLOTTE NC
28202-3260
US

V. Phone/Fax

Practice location:
  • Phone: 704-516-6046
  • Fax:
Mailing address:
  • Phone: 704-560-4332
  • Fax: 704-342-9584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HERB A GRAY III
Title or Position: CEO/OWNER
Credential:
Phone: 704-560-4332