Healthcare Provider Details

I. General information

NPI: 1659755684
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES OF SC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 E HIGHWAY 76 STE 111
MULLINS SC
29574-7396
US

IV. Provider business mailing address

9700 RESEARCH DR STE 111
CHARLOTTE NC
28262-8552
US

V. Phone/Fax

Practice location:
  • Phone: 980-265-1064
  • Fax:
Mailing address:
  • Phone: 980-265-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HERBERT GRAY
Title or Position: CEO OWNER
Credential:
Phone: 980-265-1064