Organization
LIFE, INC.
Active
Parent organization
LIFE, INC.
Other names
Life, Inc./Lockwood Street 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
156 COUNTRYSIDE DR SW, SUPPLY, NC 28462-3300
(910) 754-2854
(910) 799-3680
Mailing address
117J VILLAGE RD NE, LELAND, NC 28451-7413
(910) 371-0230
(910) 799-3680
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-010-009
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340601W
—
NC
01
—
922152
STATE FACILITY ID
NC
Enumeration date
01/23/2007
Last updated
12/15/2017
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