Provider Demographics
NPI:1053916486
Name:LIFE ENHANCEMENT HEALTH CARE INSTITUTE
Entity type:Organization
Organization Name:LIFE ENHANCEMENT HEALTH CARE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NYISHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEEMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:312-538-9702
Mailing Address - Street 1:124 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3746
Mailing Address - Country:US
Mailing Address - Phone:312-538-9702
Mailing Address - Fax:
Practice Address - Street 1:124 W 69TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3746
Practice Address - Country:US
Practice Address - Phone:312-538-9702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory