Organization
LIFE ENHANCEMENT SERVICES OF DC, LLC
Active
Organization
LIFE ENHANCEMENT SERVICES OF DC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HERBERT A GRAY III (CEO/OWNER)
(704) 342-9595
Entity
Organization
Contact information
Practice address
1310 SOUTHERN AVE SE, MEDICAL SERVICES BUILDING, WASHINGTON, DC 20032-4623
(202) 562-6262
Mailing address
1328 SOUTHERN AVE SE, MEDICAL SERVICES BUILDING, WASHINGTON, DC 20032-4689
(202) 562-6262
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050018500
—
DC
Enumeration date
11/12/2010
Last updated
04/23/2013
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