DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: LIFESOURCE OF NORTH CAROLINA

MEDICARE: LIFESOURCE OF NORTH CAROLINA
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
1103TC0700XClinical Psychologist
22084P0800XPsychiatry Physician
3363A00000XPhysician Assistant
4363L00000XNurse Practitioner
51041C0700XClinical Social Worker

General Provider Information

NPI Number : 1114419124
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFESOURCE OF NORTH CAROLINA
Provider Business Mailing Address
First Line : PO BOX 538622
Second Line :
City : ATLANTA
State : GA
Zip : 30353-8622
Country : US
Telephone Number : 910-742-9243
Fax Number :
Provider Business Practice Location Address
First Line : 1901 LIBBIE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23226-1808
Country : US
Telephone Number : 910-742-9243
Fax Number : 888-746-1787
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : PEGGY BADDOUR
Credential :
Telephone Number : 910-777-9165
Provider Enumeration Date : 06/05/2018
Last Update Date : 03/25/2021

Similar Medicare Providers

1073154373 — GLENBURNIE OPERATOR LLC
Practice Location Address:
1901 LIBBIE AVE
RICHMOND, VA
23226-1808
Practice Phone: 804-281-3500
Practice Fax:
1992340970 — MRS. AMY B MITCHELL LCSW
Practice Location Address:
1901 LIBBIE AVE
RICHMOND, VA
23226-1808
Practice Phone: 910-742-9243
Practice Fax: 888-746-1787
1275377228 — MRS. AMANDA KRASNOFF DUNKLEY CCC-SLP
Practice Location Address:
1901 LIBBIE AVE
RICHMOND, VA
23226-1808
Practice Phone: 804-281-3500
Practice Fax:
1326831058 — CHARTISHA WINSTON
Practice Location Address:
1901 LIBBIE AVE
RICHMOND, VA
23226-1808
Practice Phone: 804-281-3500
Practice Fax:
1811888647 — MACKENZIE LAKE COLLETON DPT
Practice Location Address:
1901 LIBBIE AVE
RICHMOND, VA
23226-1808
Practice Phone: 804-281-3501
Practice Fax:
1548124159 — LIFESOURCE PRIME INC
Practice Location Address:
1901 LIBBIE AVE
RICHMOND, VA
23226-1808
Practice Phone: 910-742-9243
Practice Fax: 888-746-1787

Directions to “LIFESOURCE OF NORTH CAROLINA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.