NPIMap

Organization Active NPI

Life, Inc.

  • Community/Behavioral Health Agency
  • Edenton, NC
National Provider Identifier
1376059501
Registry record updated Dec 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-021-009 Issued in NC
Legal business name
LIFE, INC.
Doing business as
Edenton Day Program
Practice address
701 N Broad St Ste D
Edenton, NC 27932-1462
Phone
(252) 482-8666
NPI assigned
Dec 26, 2017
Organization subpart
Yes
Parent organization
LIFE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 26, 2017

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X MHL-021-009 NC
Community/Behavioral Health Agency 251S00000X MHL-021-009 NC Primary

Addresses

Primary practice location

701 N Broad St Ste D
Edenton, NC 27932-1462

Mailing address

PO Box 70
Edenton, NC 27932-0070
Phone (252) 482-8666

Other identifiers 1

IdentifierTypeStateIssuer
3408694MedicaidNC

Other names 1

  • Edenton Day Program Doing business as

National Provider Directory

National Provider Directory
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.

View all 47

Locations

701 N Broad St
Ste D
Edenton, NC 27932
Phone (252) 482-8666

NPI Registry JSON

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

{
    "created_epoch": "1514246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514246400000",
    "number": "1376059501",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N BROAD ST STE D",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321462",
            "telephone_number": "252-482-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE, INC.",
        "enumeration_date": "2017-12-26",
        "last_updated": "2017-12-26",
        "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": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "MHL-021-009",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-021-009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408694",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edenton Day Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edenton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.