Organization
LIFEGATE RESIDENTIAL CARE
Active
Other names
Lifegate Residential Care
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CLEOLA MAE MARTIN (PROGRAM MANAGER)
(919) 779-2209
Entity
Organization
Contact information
Practice address
209 WHITE OAK FARMS DR, WILLOW SPRING, NC 27592-8534
(919) 639-2777
(919) 779-2955
Mailing address
209 WHITE OAK FARMS DR, WILLOW SPRING, NC 27592-8534
(919) 639-2777
(919) 779-2955
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
MHL-051-157
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-051-157NC
NC
Other
Enumeration date
04/18/2007
Last updated
09/11/2025
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