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Organization
LIFE, INC.
Active
Organization
LIFE, INC.
Active
Parent organization
LIFE, INC.
Other names
LIFE, Inc./Beaufort Heights Group Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFE, INC.
Authorized official
RICHARD LYNN SMITH (VP OF BUSINESS OPERATIONS)
(919) 778-1900
Entity
Organization
Contact information
Practice address
103 CIRCLE ST, WASHINGTON, NC 27889-9026
(252) 946-4133
(252) 974-1211
Mailing address
1827 CAROLINA AVE, WASHINGTON, NC 27889-3369
(252) 974-2600
(252) 974-1211
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-007-014
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340610Y
—
NC
01
—
956891
STATE FACILITY ID
NC
Enumeration date
01/22/2007
Last updated
12/15/2017
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