Healthcare Provider Details

I. General information

NPI: 1316172141
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES - TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MINNA PL
MEMPHIS TN
38104-4607
US

IV. Provider business mailing address

1180 MINNA PL
MEMPHIS TN
38104-4607
US

V. Phone/Fax

Practice location:
  • Phone: 901-336-8414
  • Fax: 901-328-1402
Mailing address:
  • Phone: 901-336-8414
  • Fax: 901-328-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK YATES
Title or Position: CEO
Credential:
Phone: 901-336-8414