Life, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

MHL-021-007 Issued in NC

Legal business name

LIFE, INC.

Practice address

249 Coke Ave
Edenton, NC 27932-1522

Phone

(252) 482-5357

Fax

(252) 482-8881

NPI assigned

Jan 23, 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

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 1245384601. Details of each certification follow.

• CCN 34G330 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G330

Legal name

LIFE, INC CHOWAN GROUP HOME

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jul 19, 1995

Last certification

Sep 3, 2025

Beds

6

Ownership / control type

Private (proprietary)

Most recent change of ownership

Oct 16, 2018

Facility address

249 Coke Ave
Edenton, NC 27932

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": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513296000000",
    "number": "1245384601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279320070",
            "telephone_number": "252-482-8666",
            "fax_number": "252-482-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 COKE AVE",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321522",
            "telephone_number": "252-482-5357",
            "fax_number": "252-482-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE, INC.",
        "enumeration_date": "2007-01-23",
        "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-021-007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY ID",
            "identifier": "955734",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340610P",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Haley Koppelman, DDS
• Christine F Landis, CRNA
• Sandra J Layden, FNP
• Leibert E. Devine MD PA (Family Medicine of Edenton)
• Life, Inc.
• Life, Inc.
• Life, Inc. (LIFE, Inc./Albemarle Group Home)
• Life, Inc. (Edenton Day Program)
• Life, Inc. (Luke Street Facility - Edenton)
• Living the Breamedical - Edenton, PLLC

• Intellectual Disabilities Intermediate Care Facility in Edenton, NC
• Providers in Edenton, 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.