Healthcare Provider Details

I. General information

NPI: 1013178524
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES OF LOUISIANA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SAINT CHARLES AVE SUITE 208
NEW ORLEANS LA
70130-5268
US

IV. Provider business mailing address

230 S TRYON ST UNIT 1010
CHARLOTTE NC
28202-3215
US

V. Phone/Fax

Practice location:
  • Phone: 704-516-6046
  • Fax: 704-342-9584
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 AUTHUR GRAY III
Title or Position: CEO/OWNER
Credential:
Phone: 704-560-4332