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NPI Code Detail

MEDICARE: LIFE ENRICHMENT CENTER

MEDICARE: LIFE ENRICHMENT CENTER
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
1251C00000XDevelopmentally Disabled Services Day Training Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912103532
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFE ENRICHMENT CENTER
Provider Business Mailing Address
First Line : 103 TR HARRIS DRIVE
Second Line :
City : SHELBY
State : NC
Zip : 28150
Country : US
Telephone Number : 704-484-0405
Fax Number : 704-484-0406
Provider Business Practice Location Address
First Line : 103 T R HARRIS DR
Second Line :
City : SHELBY
State : NC
Zip : 28150-3486
Country : US
Telephone Number : 704-484-0405
Fax Number : 704-484-0406
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : SUZI KENNEDY
Credential : RN
Telephone Number : 704-484-0405
Provider Enumeration Date : 06/21/2007
Last Update Date : 08/22/2020

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Directions to “LIFE ENRICHMENT CENTER ” Practice Location

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