Provider Demographics
| NPI: | 1558062745 |
|---|---|
| Name: | LIFE ENRICHMENT DAY CENTER LLC |
| Entity type: | Organization |
| Organization Name: | LIFE ENRICHMENT DAY CENTER LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | GARNETTA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MCADAMS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 336-263-6860 |
| Mailing Address - Street 1: | PO BOX 2554 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BURLINGTON |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 27216-2554 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 336-263-6860 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1522 VAUGHN RD |
| Practice Address - Street 2: | |
| Practice Address - City: | BURLINGTON |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27217-2871 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 336-270-5155 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-03-14 |
| Last Update Date: | 2023-03-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| No | 251E00000X | Agencies | Home Health | ||
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | |
| No | 273Y00000X | Hospital Units | Rehabilitation Unit | ||
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
