Provider Demographics
NPI:1144834946
Name:LIFE ENHANCEMENT SERVICES OF NC LLC
Entity type:Organization
Organization Name:LIFE ENHANCEMENT SERVICES OF NC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-560-4332
Mailing Address - Street 1:13016 EASTFIELD RD STE 200-269
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6622
Mailing Address - Country:US
Mailing Address - Phone:704-560-4332
Mailing Address - Fax:
Practice Address - Street 1:13016 EASTFIELD RD STE 200-269
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6622
Practice Address - Country:US
Practice Address - Phone:704-560-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health