Healthcare Provider Details

I. General information

NPI: 1578184594
Provider Name (Legal Business Name): LIFE-WAY HOMES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7919 MOSSYCUP DR
CHARLOTTE NC
28215-7159
US

IV. Provider business mailing address

1 BUFFALO AVE NW STE 201
CONCORD NC
28025-4004
US

V. Phone/Fax

Practice location:
  • Phone: 301-257-0640
  • Fax:
Mailing address:
  • Phone: 980-859-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SABINA BENEL
Title or Position: DIRECTOR/OWNER
Credential: PMHNP, FNP, DNP
Phone: 301-257-0640