Organization
LIFE, INC.
Active
Parent organization
LIFE, INC.
Other names
McKeel Loop Road 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
5910 FARMWOOD LOOP, WILSON, NC 27896-8007
(252) 291-9647
(252) 291-0812
Mailing address
2609 ROYALL AVE, GOLDSBORO, NC 27534-8615
(919) 778-1900
(919) 778-1900
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-098-012
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340603U
—
NC
01
—
922202
STATE FACILITY ID
NC
Enumeration date
01/22/2007
Last updated
12/15/2017
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