Healthcare Provider Details

I. General information

NPI: 1295979706
Provider Name (Legal Business Name): LIFE AND HOPE OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 GREENCASTLE CT APT C
RALEIGH NC
27604-2626
US

IV. Provider business mailing address

4209 GREENCASTLE CT APT C
RALEIGH NC
27604-2626
US

V. Phone/Fax

Practice location:
  • Phone: 919-673-6880
  • Fax:
Mailing address:
  • Phone: 919-673-6880
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA RAY
Title or Position: OWNER
Credential:
Phone: 919-673-6880