# LIFEGATE RESIDENTIAL CARE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lifegate Residential Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023234671
- **Authorized official:** MS. CLEOLA MAE MARTIN (PROGRAM MANAGER)
- **Authorized official phone:** (919) 779-2209

## Contact information

- **Practice address:** 209 WHITE OAK FARMS DR, WILLOW SPRING, NC 27592-8534
- **Practice address phone:** (919) 639-2777
- **Practice address fax:** (919) 779-2955
- **Mailing address:** 209 WHITE OAK FARMS DR, WILLOW SPRING, NC 27592-8534
- **Mailing address phone:** (919) 639-2777
- **Mailing address fax:** (919) 779-2955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | MHL-051-157 | NC | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-051-157NC | NC | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 09/11/2025