34D2156772 CLIA NUMBER - LIFE INC / EDGEWOOD GROUP HOME

Laboratory Demographics

CLIA Number: 34D2156772

Facility Name: LIFE INC / EDGEWOOD GROUP HOME

Facility Address:
77 EDGEWOOD DRIVE
CHOCOWINITY, NC
ZIP 27817
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Facility Phone Number: 252 974-2600

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1043364672

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	34D2156772
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	LIFE INC / EDGEWOOD GROUP HOME
Street	77 EDGEWOOD DRIVE
City	CHOCOWINITY
State	NC
ZIP	27817
Phone	252 974-2600
CertificateType	4
CertificateEffectiveDate	10/24/2022
CertificateExpirationDate	10/23/2024
FacilityType	Waiver

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