| Life Enhancement Services Of Dc, Llc | |
|
1310 Southern Ave Se Medical Services Building Washington DC 20032-4623 | |
| (202) 562-6262 | |
| Not Available |
| Full Name | Life Enhancement Services Of Dc, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1310 Southern Ave Se, Washington, District Of Columbia |
| Authorized Official Name and Position | Herbert A Gray (CEO/OWNER) |
| Authorized Official Contact | 7043429595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Enhancement Services Of Dc, Llc 1328 Southern Ave Se Medical Services Building Washington DC 20032-4689 Ph: (202) 562-6262 | Life Enhancement Services Of Dc, Llc 1310 Southern Ave Se Medical Services Building Washington DC 20032-4623 Ph: (202) 562-6262 |
| NPI Number | 1750682357 |
|---|---|
| Provider Enumeration Date | 11/12/2010 |
| Last Update Date | 04/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750682357 | NPI | - | NPPES |
| 050018500 | Medicaid | DC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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