Healthcare Provider Details

I. General information

NPI: 1255509550
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W CHAPEL HILL ST SUITE 902
DURHAM NC
27701-3616
US

IV. Provider business mailing address

411 W CHAPEL HILL ST SUITE 902
DURHAM NC
27701-3616
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-7176
  • Fax: 919-682-2339
Mailing address:
  • Phone: 919-956-7176
  • Fax: 919-682-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: DAWN COLLINS
Title or Position: DIRECTOR OF CLINICAL OPERATIONS
Credential:
Phone: 704-342-9595