NPIMap

Organization Active NPI

Life, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Washington, NC
National Provider Identifier
1013061944
Registry record updated Dec 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL-007-014 Issued in NC
Legal business name
LIFE, INC.
Practice address
103 Circle St
Washington, NC 27889-9026
Phone
(252) 946-4133
Fax
(252) 974-1211
NPI assigned
Jan 22, 2007
Organization subpart
Yes
Parent organization
LIFE, INC.As reported in NPPES

Authorized official

NPPES NPI Registry
Name
Richard Lynn Smith
Title
VP of Business Operations
Phone
(919) 778-1900

Corporate family (same tax ID) 47

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

View all 47

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2033932Life Inc Beaufort Heights Group Home103 Circle Street, Washington, NC 27889Certificate of waiverDec 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Life Inc (48 organizations share this tax ID)
Part of
Life Inc

Locations

1827 Carolina Ave
Washington, NC 27889

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-007-014 NC Primary

Addresses

NPPES NPI Registry

Primary practice location

103 Circle St
Washington, NC 27889-9026

Mailing address

1827 Carolina Ave
Washington, NC 27889-3369
Phone (252) 974-2600

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
340610YMedicaidNC
956891OtherNCSTATE FACILITY ID

Other names 1

NPPES NPI Registry
  • LIFE, Inc./Beaufort Heights Group Home Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 15, 2017.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513296000000",
    "number": "1013061944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1827 CAROLINA AVE",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278893369",
            "telephone_number": "252-974-2600",
            "fax_number": "252-974-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 CIRCLE ST",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278899026",
            "telephone_number": "252-946-4133",
            "fax_number": "252-974-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE, INC.",
        "enumeration_date": "2007-01-22",
        "last_updated": "2017-12-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "919-778-1900"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-007-014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340610Y",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY ID",
            "identifier": "956891",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFE, Inc./Beaufort Heights Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.