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General NPI Number Information
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NPI Number | 1477058899
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Entity Type | Organization
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Legal Business Name | LIFE JOURNEY CARE
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 898 RIVER HILL RD
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City | STATESVILLE
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State | NC
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Zip | 28625-9112
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Country | US
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Telephone | 336-255-0854
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Fax |
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Provider Business Mailing Address
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Address Line | 898 RIVER HILL RD
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City | STATESVILLE
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State | NC
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Zip | 28625-9112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AISHA CAMPBELL
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Credential |
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Telephone | 336-255-0854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | IHCP-0819
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License Number State | SC
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