NPIMap

Organization Active NPI

Life Enhancement Services of DC, LLC

  • Community/Behavioral Health Agency
  • Washington, DC
National Provider Identifier
1750682357
Registry record updated Apr 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LIFE ENHANCEMENT SERVICES OF DC, LLC
Practice address
1310 Southern Ave SE
Medical Services Building
Washington, DC 20032-4623
Phone
(202) 562-6262
NPI assigned
Nov 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2013

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

1310 Southern Ave SE
Medical Services Building
Washington, DC 20032-4623

Mailing address

1328 Southern Ave SE
Medical Services Building
Washington, DC 20032-4689
Phone (202) 562-6262

Other identifiers 1

IdentifierTypeStateIssuer
050018500MedicaidDC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1289520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366675200000",
    "number": "1750682357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1328 SOUTHERN AVE SE",
            "address_2": "MEDICAL SERVICES BUILDING",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200324689",
            "telephone_number": "202-562-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 SOUTHERN AVE SE",
            "address_2": "MEDICAL SERVICES BUILDING",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200324623",
            "telephone_number": "202-562-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ENHANCEMENT SERVICES OF DC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-12",
        "last_updated": "2013-04-23",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO/OWNER",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050018500",
            "state": "DC"
        }
    ],
    "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 Apr 23, 2013; 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.