34D2033883 CLIA NUMBER - LIFE, INC MINUTEMAN

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Laboratory Demographics

CLIA Number: 34D2033883

Facility Name: LIFE, INC MINUTEMAN

Facility Address:
388 MINUTEMAN LANE
WASHINGTON, NC
ZIP 27889
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Facility Phone Number: 252 946-5563

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1356495733

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	34D2033883
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	LIFE, INC MINUTEMAN
Street	388 MINUTEMAN LANE
City	WASHINGTON
State	NC
ZIP	27889
Phone	252 946-5563
CertificateType	4
CertificateEffectiveDate	12/13/2023
CertificateExpirationDate	12/12/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024