MEDICARE: LIFE OPPORTUNITIES 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1750030748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE OPPORTUNITIES INC

Provider Business Mailing Address
First Line	:	PO BOX 448
Second Line	:
City	:	SHANNON
State	:	NC
Zip	:	28386-0448
Country	:	US
Telephone Number	:	910-733-2562
Fax Number	:	910-843-1295

Provider Business Practice Location Address
First Line	:	4224 MCLEOD ROAD
Second Line	:
City	:	RED SPRINGS
State	:	NC
Zip	:	28377
Country	:	US
Telephone Number	:	910-359-8046
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DONALD MCMILLAN
Credential	:
Telephone Number	:	910-843-1105

Provider Enumeration Date	:	03/18/2022
Last Update Date	:	03/18/2022

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