Healthcare Provider Details

I. General information

NPI: 1174856066
Provider Name (Legal Business Name): LIFE ENHANCEMENT CHARITABLE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 2ND AVE STE 4
GASTONIA NC
28054-7144
US

IV. Provider business mailing address

701 E 2ND AVE STE 4
GASTONIA NC
28054-7144
US

V. Phone/Fax

Practice location:
  • Phone: 704-342-9595
  • Fax:
Mailing address:
  • Phone: 704-342-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HOUSTON MCGOWAN
Title or Position: PRESIDENT OF THE BOARD
Credential:
Phone: 704-342-9595