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General NPI Number Information
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NPI Number | 1659755684
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Entity Type | Organization
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Legal Business Name | LIFE ENHANCEMENT SERVICES OF SC, LLC
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 3040 E HIGHWAY 76 STE 111
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City | MULLINS
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State | SC
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Zip | 29574-7396
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Country | US
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Telephone | 980-265-1064
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Fax |
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Provider Business Mailing Address
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Address Line | 9700 RESEARCH DR STE 111
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City | CHARLOTTE
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State | NC
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Zip | 28262-8552
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Country | US
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Telephone | 980-265-1064
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Fax |
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Authorized Official
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Title or Position | CEO OWNER
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Name | HERBERT GRAY
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Credential |
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Telephone | 980-265-1064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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