Organization
LIFE, INC.
Active
Parent organization
LIFE, INC.
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
2767 WILD CAT RD, WILLIAMSTON, NC 27892-8946
(252) 792-9158
(252) 974-1211
Mailing address
PO BOX 1507, WASHINGTON, NC 27889-1507
(252) 974-2600
(252) 974-1211
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-058-006
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340610G
—
NC
01
—
955544
STATE FACILITY ID
NC
Enumeration date
01/22/2007
Last updated
12/15/2017
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