Provider Demographics
NPI:1104015759
Name:LIFE ENHANCEMENT SERVICES
Entity type:Organization
Organization Name:LIFE ENHANCEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HERB
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-342-9595
Mailing Address - Street 1:500 E MOREHEAD ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2606
Mailing Address - Country:US
Mailing Address - Phone:704-342-9595
Mailing Address - Fax:704-342-9588
Practice Address - Street 1:500 E MOREHEAD ST STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2606
Practice Address - Country:US
Practice Address - Phone:704-342-9595
Practice Address - Fax:704-342-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health