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NPI Code Detail

MEDICARE: LIFE ENRICHMENT CENTER LLC

MEDICARE: LIFE ENRICHMENT CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS 2132KS
2106H00000XMarriage & Family TherapistLCMFT 246KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1180505OTHERKSBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831179266
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFE ENRICHMENT CENTER LLC
Provider Business Mailing Address
First Line : 4000 W 6TH ST # 130
Second Line :
City : LAWRENCE
State : KS
Zip : 66049-3204
Country : US
Telephone Number : 785-842-2752
Fax Number : 785-842-2750
Provider Business Practice Location Address
First Line : 2619 W 6TH ST STE G
Second Line :
City : LAWRENCE
State : KS
Zip : 66049-4300
Country : US
Telephone Number : 785-842-2752
Fax Number : 785-842-2750
Authorized Official
Title or Position : PARTNER
Name : MR. EDWARD C BLOCH
Credential : LSCSW
Telephone Number : 785-842-2752
Provider Enumeration Date : 01/20/2006
Last Update Date : 02/03/2019

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Directions to “LIFE ENRICHMENT CENTER LLC ” Practice Location

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