Organization
LIFE, INC.
Active
Parent organization
LIFE, INC.
Other names
Life/Raven Ridge 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
4105 RAVEN RIDGE DR NW, WILSON, NC 27896-9656
(252) 291-8348
(252) 291-0812
Mailing address
2609 ROYALL AVE, GOLDSBORO, NC 27534-8615
(919) 778-1900
(919) 778-1972
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-098-011
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340603H
—
NC
01
—
922436
STATE FACILITY ID
NC
Enumeration date
01/23/2007
Last updated
12/15/2017
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