NPIMap

Organization Active NPI

Lifetime Resources, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Wilmington, NC
National Provider Identifier
1003021874
Registry record updated Jul 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
3406452 Issued in NC
Legal business name
LIFETIME RESOURCES, INC.
Practice address
220 Dorchester PL
Wilmington, NC 28412-7324
Phone
(910) 762-1189
Fax
(910) 762-1301
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert T. Thacker, Jr., PH.D.
Title
Executive Director
Phone
(910) 762-1189

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 3406452 NC Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 3406452 NC

Addresses

Primary practice location

220 Dorchester PL
Wilmington, NC 28412-7324

Mailing address

1316 S. 16TH Street
Wilmington, NC 28401-6422
Phone (910) 762-1189

Other identifiers 1

IdentifierTypeStateIssuer
3406452MedicaidNC

Other names 1

  • Echo Farms Group Home Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G100

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LIFETIME RESOURCES, INC ECHO FARMS GROUP HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Nov 30, 1988
Last certification
Apr 29, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
220 Dorchester Place
Wilmington, NC 28412

National Provider Directory

National Provider Directory
Tax ID family
Echo Farms Group Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499385600000",
    "number": "1003021874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1316 S. 16TH STREET",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016422",
            "telephone_number": "910-762-1189",
            "fax_number": "910-762-1301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 DORCHESTER PL",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284127324",
            "telephone_number": "910-762-1189",
            "fax_number": "910-762-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME RESOURCES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2017-07-07",
        "status": "A",
        "authorized_official_last_name": "THACKER, JR.",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-762-1189",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "3406452",
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "3406452",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406452",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Echo Farms Group Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.