Organization
LIFE, INC.
Active
Parent organization
LIFE, INC.
Other names
Edenton Day Program
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
701 N BROAD ST STE D, EDENTON, NC 27932-1462
(252) 482-8666
Mailing address
PO BOX 70, EDENTON, NC 27932-0070
(252) 482-8666
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
MHL-021-009
NC
251S00000X
Community/Behavioral Health Agency
Primary
MHL-021-009
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408694
—
NC
Enumeration date
12/26/2017
Last updated
12/26/2017
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