MEDICARE: LIFE SKILLS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1053571547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SKILLS, INC.

Provider Business Mailing Address
First Line	:	405 MORSON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27601-1559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 MORSON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27601-1559
Country	:	US
Telephone Number	:	919-427-4465
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	CYNTHIA WATSON
Credential	:
Telephone Number	:	919-427-4465

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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