1649407990 NPI number — LIFE ENHANCEMENT SERVICES

Table of content: (NPI 1649407990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649407990 NPI number — LIFE ENHANCEMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE ENHANCEMENT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649407990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 W CHAPEL HILL ST
Provider Second Line Business Mailing Address:
SUITE 902
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27701-3616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-956-7176
Provider Business Mailing Address Fax Number:
919-682-2339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3274 ROSEHILL RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-264-2253
Provider Business Practice Location Address Fax Number:
919-882-9488
Provider Enumeration Date:
06/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
HERB
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
919-956-7176

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)