| Life Enhancement Center | |
|
1835 N 1120 W Provo UT 84604-1180 | |
| (801) 623-4770 | |
| (801) 623-4771 |
| Full Name | Life Enhancement Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1835 N 1120 W, Provo, Utah |
| Authorized Official Name and Position | Russell C Gaede (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8016234770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Enhancement Center 1835 N 1120 W Provo UT 84604-1180 Ph: (801) 623-4770 | Life Enhancement Center 1835 N 1120 W Provo UT 84604-1180 Ph: (801) 623-4770 |
| NPI Number | 1083876734 |
|---|---|
| Provider Enumeration Date | 06/25/2008 |
| Last Update Date | 06/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083876734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6332186-0142 (Utah) | Primary |
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