Healthcare Provider Details

I. General information

NPI: 1487888475
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 2ND AVE SUITE 5
GASTONIA NC
28054-7144
US

IV. Provider business mailing address

500 E MOREHEAD ST 110
CHARLOTTE NC
28202-2616
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 TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HERB GRAY
Title or Position: OWNER
Credential:
Phone: 704-342-9595