Organization
LIFE, INC.
Active
Parent organization
LIFE, INC.
Other names
Life, Inc./King Street Group Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFE, INC.
Authorized official
RICHARD LYNN SMITH (SENIOR VICE PRESIDENT/CFO)
(919) 778-1900
Entity
Organization
Contact information
Practice address
117 SOUTH KING STREET, HALIFAX, NC 27839-0446
(252) 583-1984
(252) 583-1615
Mailing address
PO BOX 446, HALIFAX, NC 27839-0446
(252) 583-1984
(252) 583-1615
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-042-028
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340612A
—
NC
01
—
970428
STATE FACILITY ID
NC
Enumeration date
01/23/2007
Last updated
07/14/2023
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