Organization
LIFE, INC.
Active
Parent organization
LIFE, INC.
Other names
Idlewood Group Home
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
28 WOOD GLEN RD, ROANOKE RAPIDS, NC 27870-6285
(252) 537-4686
(252) 583-1615
Mailing address
PO BOX 446, HALIFAX, NC 27839-0446
(252) 537-4686
(252) 583-1615
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-042-009
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3416196
—
NC
01
—
922027
STATE FACILITY ID
NC
Enumeration date
01/22/2007
Last updated
12/15/2017
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