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Organization

LIFE, INC.

Active
Parent organization
LIFE, INC.
Other names
LIFE, Inc/Green Tee Lane
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
1320 GREEN TEE LN, ROCKY MOUNT, NC 27804-9635
(252) 972-6975
(252) 212-0135
Mailing address
PO BOX 446, HALIFAX, NC 27839-0446
(252) 972-6975
(252) 212-0135

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-064-020
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
340606M
NC
01
944709
STATE FACILITY ID
NC
Enumeration date
01/22/2007
Last updated
12/15/2017
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