LIFE INC. NPI 1043364672

NPI Information

NPI: 1043364672
Provider Name: LIFE, INC.
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

CLIA Number: 34D2156772

Address:
2767 WILD CAT RD
WILLIAMSTON, NC
ZIP 27892
Phone: (252) 792-9158
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LIFE, INC. is an intermediate care facility mentally retarded in Williamston, NC. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. LIFE, INC. NPI is 1043364672. The provider is registered as an organization entity type.

The provider's business location address is:

2767 WILD CAT RD
WILLIAMSTON, NC
ZIP 27892-946
Phone: (252) 792-9158
Fax: (252) 974-1211

The provider's authorized official is Richard Lynn Smith .
The authorized official title is Vp Of Business Operations and has the following contact phone number (919) 778-1900.

The CLIA number assigned to this NPI record is 34D2156772 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/22/2007 and was last updated on 12/15/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		MHL-058-006	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	955544	OTHER	NORTH CAROLINA	STATE FACILITY ID
2	340610G	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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