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General NPI Number Information
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NPI Number | 1285990408
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Entity Type | Organization
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Legal Business Name | LIFE ENHANCEMENT SERVICES LLC
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 100 BRUNSWICK AVE
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City | EMPORIA
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State | VA
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Zip | 23847-2028
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Country | US
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Telephone | 434-336-1103
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Fax | 434-336-1105
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Provider Business Mailing Address
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Address Line | 100 BRUNSWICK AVE
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City | EMPORIA
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State | VA
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Zip | 23847-2028
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Country | US
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Telephone | 434-336-1103
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Fax | 434-336-1105
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Authorized Official
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Title or Position | MANAGER/PROGRAM DIRECTOR
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Name | BERNICE L LEE
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Credential | M.ED, BA, CSAC-I
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Telephone | 252-287-7870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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