NPIMap

Organization Active NPI

Life, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Wilson, NC
National Provider Identifier
1437203890
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-098-011 Issued in NC
Legal business name
LIFE, INC.
Practice address
4105 Raven Ridge Dr NW
Wilson, NC 27896-9656
Phone
(252) 291-8348
Fax
(252) 291-0812
NPI assigned
Jan 23, 2007
Organization subpart
Yes
Parent organization
LIFE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 15, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-098-011 NC Primary

Addresses

Primary practice location

4105 Raven Ridge Dr NW
Wilson, NC 27896-9656

Mailing address

2609 Royall Ave
Goldsboro, NC 27534-8615
Phone (919) 778-1900

Other identifiers 2

IdentifierTypeStateIssuer
340603HMedicaidNC
922436OtherNCSTATE FACILITY ID

Other names 1

  • Life/Raven Ridge Group Home 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

NPI Registry JSON

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": "1437203890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2609 ROYALL AVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275348615",
            "telephone_number": "919-778-1900",
            "fax_number": "919-778-1972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 RAVEN RIDGE DR NW",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278969656",
            "telephone_number": "252-291-8348",
            "fax_number": "252-291-0812"
        }
    ],
    "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-098-011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340603H",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY ID",
            "identifier": "922436",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life/Raven Ridge Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilson, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.