Organization
LIFETIME RESOURCES, INC.
Active
Other names
Echo Farms Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT T. THACKER, JR. PH.D. (EXECUTIVE DIRECTOR)
(910) 762-1189
Entity
Organization
Contact information
Practice address
220 DORCHESTER PL, WILMINGTON, NC 28412-7324
(910) 762-1189
(910) 762-1301
Mailing address
1316 S. 16TH STREET, WILMINGTON, NC 28401-6422
(910) 762-1189
(910) 762-1301
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
3406452
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
3406452
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406452
—
NC
Enumeration date
05/14/2007
Last updated
07/07/2017
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