34D2174631 CLIA NUMBER - LIFE INCORPORATED DIXON ROAD GROUP HOME

Laboratory Demographics

  • CLIA Code: 34D2174631
  • Facility Name: LIFE INCORPORATED DIXON ROAD GROUP HOME
  • Facility Address: 1383 DIXON ROAD
    CHOCOWINITY, NC
    ZIP 27817
  • Facility Phone: 252 975-1220
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: KIM K. MCINTYRE
  • NPI Number: 1285788026
  • Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities

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CLIA Record

Field Name Field Value
CLIA Number 34D2174631
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name LIFE INCORPORATED DIXON ROAD GROUP HOME
Street 1383 DIXON ROAD
City CHOCOWINITY
State NC
ZIP 27817
Phone 252 975-1220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2023
Certificate Expiration Date 11/4/2025
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director KIM K. MCINTYRE

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This page was last updated on: 9/29/2025