Provider Demographics
NPI:1992498067
Name:THE LIFE ENRICHMENT CENTER, INC.
Entity type:Organization
Organization Name:THE LIFE ENRICHMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-445-7176
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-0644
Mailing Address - Country:US
Mailing Address - Phone:478-445-7176
Mailing Address - Fax:478-445-2964
Practice Address - Street 1:1111 N JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2531
Practice Address - Country:US
Practice Address - Phone:478-445-7176
Practice Address - Fax:478-445-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services