Healthcare Provider Details

I. General information

NPI: 1386705861
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 11TH ST
LUMBERTON NC
28358-4807
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 910-738-4000
  • Fax: 910-738-4067
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 III
Title or Position: OWNER
Credential:
Phone: 919-956-7176