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General NPI Number Information
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NPI Number | 1942354303
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Entity Type | Organization
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Legal Business Name | LIFE, INC.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 117 SOUTH KING STREET
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City | HALIFAX
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State | NC
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Zip | 27839-0446
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Country | US
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Telephone | 252-583-1984
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Fax | 252-583-1615
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Provider Business Mailing Address
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Address Line | PO BOX 446
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City | HALIFAX
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State | NC
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Zip | 27839-0446
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Country | US
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Telephone | 252-583-1984
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Fax | 252-583-1615
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT/CFO
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Name | RICHARD LYNN SMITH
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Credential |
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Telephone | 919-778-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | MHL-042-028
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License Number State | NC
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