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General NPI Number Information
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NPI Number | 1316191869
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Entity Type | Organization
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Legal Business Name | LIFE DOMAINS, LLC
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 1656 NORTH GLENCOE ROAD
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City | BURLINGTON
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State | NC
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Zip | 27215
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Country | US
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Telephone | 336-269-4048
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 N CHURCH ST SUITE G
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City | BURLINGTON
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State | NC
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Zip | 27217-2702
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Country | US
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Telephone | 336-269-4048
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TOYA STEPHENS
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Credential |
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Telephone | 336-269-4048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NC
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