1821254053 NPI number — LIFE ENHANCEMENT SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821254053 NPI number — LIFE ENHANCEMENT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE ENHANCEMENT SERVICES, INC.
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:
1821254053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 EASTSIDE ST
Provider Second Line Business Mailing Address:
103
Provider Business Mailing Address City Name:
TUSKEGEE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36083-1701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-727-1122
Provider Business Mailing Address Fax Number:
334-727-7277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 EASTSIDE ST.
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
TUSKEGEE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36083-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-727-1122
Provider Business Practice Location Address Fax Number:
334-727-7277
Provider Enumeration Date:
08/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CRAYTON
Authorized Official First Name:
DEMETRIUS
Authorized Official Middle Name:
JERMAINE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
704-299-2821

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com