Organization
LIFE ENHANCEMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEMETRIUS CRAYTON (EXECUTIVE DIRECTOR)
(704) 241-9722
Entity
Organization
Contact information
Practice address
203 CAMPBELL DR, TUSKEGEE, AL 36083-2315
(704) 241-9722
Mailing address
500 E MOREHEAD ST, SUITE 110, CHARLOTTE, NC 28202-2616
(704) 342-9595
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
UNSPECIFIED
—
AL
Enumeration date
03/17/2008
Last updated
03/17/2008
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