NPIMap

Organization Active NPI

Life Enhancement Services of VA, LLC

  • Community/Behavioral Health Agency
  • Washington, DC
National Provider Identifier
1336485366
Registry record updated Dec 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LIFE ENHANCEMENT SERVICES OF VA, LLC
Practice address
1328 Southern Ave SE
Suite 301
Washington, DC 20032-4689
Phone
(877) 845-8169
NPI assigned
Dec 19, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Herbert Gray III
Title
Ceo
Phone
(704) 342-9595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1328 Southern Ave SE
Suite 301
Washington, DC 20032-4689

Mailing address

500 E Morehead St
Suite 110
Charlotte, NC 28202-2616
Phone (704) 342-9595

National Provider Directory

National Provider Directory

Locations

1328 Southern Ave SE
Ste 301
Washington, DC 20032
Phone (202) 562-6252

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355875200000",
    "number": "1336485366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E MOREHEAD ST",
            "address_2": "SUITE 110",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282022616",
            "telephone_number": "704-342-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1328 SOUTHERN AVE SE",
            "address_2": "SUITE 301",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200324689",
            "telephone_number": "877-845-8169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ENHANCEMENT SERVICES OF VA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-19",
        "last_updated": "2012-12-19",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-342-9595",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.