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General NPI Number Information
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NPI Number | 1740428705
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Entity Type | Organization
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Legal Business Name | LIFE ENHANCEMENT CENTER
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 3595 UNIVERSITY AVE SUITE E
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City | RIVERSIDE
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State | CA
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Zip | 92501
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Country | US
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Telephone | 951-505-3552
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Fax | 951-788-2527
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Provider Business Mailing Address
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Address Line | 3595 UNIVERSITY AVE SUITE E
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City | RIVERSIDE
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State | CA
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Zip | 92501
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Country | US
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Telephone | 951-505-3552
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Fax | 951-788-2527
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Authorized Official
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Title or Position | CHEIF OPERATING OFFICER
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Name | MR. KEITH GOSHAY
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Credential | CATC
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Telephone | 951-505-3552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | CA
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