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Organization
NEW LITE LIVING CHOICES
Active
Organization
NEW LITE LIVING CHOICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY GIBBS (ADMINISTRATOR)
(704) 771-0456
Entity
Organization
Contact information
Practice address
349 COPPERFIELD BLVD NE, SUITE 5, CONCORD, NC 28025-2408
(704) 771-0456
Mailing address
PO BOX 1310, SUITE 5, CONCORD, NC 28026-1310
(704) 771-0456
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300407
—
NC
Enumeration date
05/02/2008
Last updated
03/04/2013
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