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General NPI Number Information
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NPI Number | 1942595590
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Entity Type | Organization
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Legal Business Name | LIFEPATH LLC
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Dates
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Enumeration Date | 06/11/2011
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Last Update Date | 06/11/2011
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Provider Practice Location Address
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Address Line | 5908 S NC HIGHWAY 49
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City | BURLINGTON
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State | NC
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Zip | 27215-9621
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Country | US
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Telephone | 336-255-3367
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Fax |
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Provider Business Mailing Address
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Address Line | 4565 VERNON FARMS BLVD
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City | KERNERSVILLE
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State | NC
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Zip | 27284-0130
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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 | EXECUTIVE DIRECTOR
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Name | THERESHA HILL
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Credential |
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Telephone | 336-255-3367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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