Organization
LIFE, INC.
Active
Parent organization
LIFE, INC.
Other names
Life, Inc./Lavenham 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
3700 LAVENHAM RD, NEW BERN, NC 28562-5105
(252) 633-5559
(252) 636-1725
Mailing address
PO BOX 973, NEW BERN, NC 28563-0973
(252) 636-1090
(252) 636-1725
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-025-014
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406440
—
NC
01
—
922110
STATE FACILITY ID
NC
Enumeration date
01/22/2007
Last updated
12/15/2017
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