Healthcare Provider Details

I. General information

NPI: 1760522478
Provider Name (Legal Business Name): LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LUKE ST
EDENTON NC
27932-9614
US

IV. Provider business mailing address

2609 ROYALL AVE
GOLDSBORO NC
27534-8615
US

V. Phone/Fax

Practice location:
  • Phone: 919-734-4386
  • Fax:
Mailing address:
  • Phone: 919-778-1900
  • Fax: 919-778-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-021-013
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberMHL-021-013
License Number StateNC

VIII. Authorized Official

Name: JAMES WALKER
Title or Position: DIRECTOR OF CONTRACT SERVICES
Credential:
Phone: 919-778-1900