Organization
LIFE, INC.
Active
Other names
WILSON DDA
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD LYNN SMITH (VP OF BUSINESS OPERATIONS)
(919) 778-1900
Entity
Organization
Contact information
Practice address
505 HEMPHILL ST, STANTONSBURG, NC 27883-9011
(919) 778-1900
(919) 778-1972
Mailing address
2609 ROYALL AVE, GOLDSBORO, NC 27534-8615
(919) 778-1900
(919) 778-1972
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408694
—
NC
Enumeration date
02/12/2020
Last updated
02/18/2020
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