Life, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

MHL-042-009 Issued in NC

Legal business name

LIFE, INC.

Doing business as

Idlewood Group Home

Practice address

28 Wood Glen Rd
Roanoke Rapids, NC 27870-6285

Phone

(252) 537-4686

Fax

(252) 583-1615

NPI assigned

Jan 22, 2007

Last updated

Dec 15, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

LIFE, INC.As reported in NPPES

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

Authorized official

Name

Richard Lynn Smith

Title

VP of Business Operations

Phone

(919) 778-1900

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Idlewood Group Home Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215081021. Details of each certification follow.

• CCN 34G167 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G167

Legal name

IDLEWOOD GROUP HOME

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jan 4, 1991

Last certification

Aug 26, 2025

Beds

6

Ownership / control type

Private (proprietary)

Most recent change of ownership

Sep 26, 2018

Facility address

28 Wood Glenn Road
Roanoke Rapids, NC 27870

Tax ID family

Life Inc48 organizations share this tax ID, including this one

Part of

Life Inc

Other organizations with this tax ID 47

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

• Life, Inc

  • Community/Behavioral Health Agency
  • New Bern, NC
  • NPI 1609004506
  NPD tax ID
• Life, Inc

  • Community/Behavioral Health Agency
  • Williamston, NC
  • NPI 1881822781
  NPD tax ID
• Life, Inc.

  dba LIFE, Inc./Beaufort Heights Group Home

  • Intellectual Disabilities Intermediate Care Facility
  • Washington, NC
  • NPI 1013061944
  NPD tax ID
• Life, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Washington, NC
  • NPI 1023162484
  NPD tax ID
• Life, Inc.

  dba Life, Inc./Leland Day Program

  • Community/Behavioral Health Agency
  • Leland, NC
  • NPI 1023524345
  NPD tax ID
• Life, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Newport, NC
  • NPI 1043364250
  NPD tax ID
• Life, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Williamston, NC
  • NPI 1043364672
  NPD tax ID
• Life, Inc.

  dba The Scott House

  • Adult Care Home Facility
  • Elizabeth City, NC
  • NPI 1053451765
  NPD tax ID
• Life, Inc.

  dba Life, Inc./Cherry Lane

  • Intellectual Disabilities Intermediate Care Facility
  • New Bern, NC
  • NPI 1114071032
  NPD tax ID
• Life, Inc.

  • Adult Care Home Facility
  • Roanoke Rapids, NC
  • NPI 1134260797
  NPD tax ID
• Life, Inc.

  dba Life, Inc./Folly Street Group Home

  • Intellectual Disabilities Intermediate Care Facility
  • Supply, NC
  • NPI 1134273907
  NPD tax ID
• Life, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Edenton, NC
  • NPI 1154475515
  NPD tax ID

Locations

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513296000000",
    "number": "1215081021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 446",
            "city": "HALIFAX",
            "state": "NC",
            "postal_code": "278390446",
            "telephone_number": "252-537-4686",
            "fax_number": "252-583-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 WOOD GLEN RD",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278706285",
            "telephone_number": "252-537-4686",
            "fax_number": "252-583-1615"
        }
    ],
    "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-042-009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY ID",
            "identifier": "922027",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3416196",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idlewood Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual Disabilities Intermediate Care Facility in Roanoke Rapids, NC
• Providers in Roanoke Rapids, NC by specialty
• Intellectual Disabilities Intermediate Care Facility in North Carolina

• 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 enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.