MEDICARE: LIFE, 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	315P00000X	Intellectual Disabilities Intermediate Care Facility	MHL-025-013	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	922323	OTHER	NC	STATE FACILITY ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316091796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 973
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28563-0973
Country	:	US
Telephone Number	:	252-636-1090
Fax Number	:	252-636-1725

Provider Business Practice Location Address
First Line	:	907 OAKDALE AVE
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-7131
Country	:	US
Telephone Number	:	252-636-1288
Fax Number	:	252-636-1725

Authorized Official
Title or Position	:	VP OF BUSINESS OPERATIONS
Name	:	RICHARD LYNN SMITH
Credential	:
Telephone Number	:	919-778-1900

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	12/15/2017

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Directions to “LIFE, INC. ” Practice Location

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