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General NPI Number Information
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NPI Number | 1558812461
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Entity Type | Organization
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Legal Business Name | LIFECHOICES
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 6600 W WILKINSON BLVD
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City | BELMONT
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State | NC
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Zip | 28012-2796
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Country | US
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Telephone | 704-825-4161
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Fax |
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Provider Business Mailing Address
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Address Line | 225B MARKET ST
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City | CRAMERTON
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State | NC
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Zip | 28032-1146
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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 | PRESIDENT/CEO
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Name | REGINA MOODY
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Credential |
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Telephone | 704-825-4161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 036-310
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License Number State | NC
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