Healthcare Provider Details

I. General information

NPI: 1952446619
Provider Name (Legal Business Name): WORD OF LIFE OUTEACH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9781 BLACKWELL RD SE
LELAND NC
28451-8519
US

IV. Provider business mailing address

PO BOX 661
LELAND NC
28451-0661
US

V. Phone/Fax

Practice location:
  • Phone: 910-371-5300
  • Fax: 910-371-5302
Mailing address:
  • Phone: 910-371-5300
  • Fax: 910-371-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-010-045
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-010-048
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-010-049
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-065-164
License Number StateNC

VIII. Authorized Official

Name: MR. JEFFERY A JOHNSON
Title or Position: ADMINISTRATOR
Credential: B. A.
Phone: 910-371-5300