Healthcare Provider Details

I. General information

NPI: 1649407990
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2009
Last Update Date: 06/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3274 ROSEHILL RD SUITE 1
FAYETTEVILLE NC
28301-3005
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 919-264-2253
  • Fax: 919-882-9488
Mailing address:
  • Phone: 919-956-7176
  • Fax: 919-682-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: HERB GRAY
Title or Position: CEO
Credential:
Phone: 919-956-7176