Healthcare Provider Details

I. General information

NPI: 1760548671
Provider Name (Legal Business Name): LIFEQUEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E 8TH ST
WASHINGTON NC
27889-4526
US

IV. Provider business mailing address

230 E 8TH ST
WASHINGTON NC
27889-4526
US

V. Phone/Fax

Practice location:
  • Phone: 252-975-8080
  • Fax: 252-975-8055
Mailing address:
  • Phone: 252-975-8080
  • Fax: 252-975-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMHL-007-038
License Number StateNC

VIII. Authorized Official

Name: MRS. ANGELA C HARDISON
Title or Position: DIRECTOR
Credential:
Phone: 252-975-8080