Provider Demographics
NPI:1700909785
Name:LIFE ENRICHMENT SERVICES
Entity type:Organization
Organization Name:LIFE ENRICHMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:907-868-3562
Mailing Address - Street 1:PO BOX 232245
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-2245
Mailing Address - Country:US
Mailing Address - Phone:907-868-3562
Mailing Address - Fax:907-868-3562
Practice Address - Street 1:2340 SENTRY DR APT 805
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5344
Practice Address - Country:US
Practice Address - Phone:907-868-3562
Practice Address - Fax:907-868-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK902213251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management