Healthcare Provider Details

I. General information

NPI: 1053451765
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: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 2ND ST
ELIZABETH CITY NC
27909-3627
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: 919-778-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-070-041
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberMHL-070-041
License Number StateNC

VIII. Authorized Official

Name: MR. RICHARD LYNN SMITH
Title or Position: VP OF BUSINESS OPERATIONS
Credential:
Phone: 919-778-1900