Life, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

MHL-010-009 Issued in NC

Legal business name

LIFE, INC.

Doing business as

Life, Inc./Lockwood Street Group Home

Practice address

156 Countryside Dr SW
Supply, NC 28462-3300

Phone

(910) 754-2854

Fax

(910) 799-3680

NPI assigned

Jan 23, 2007

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

• Life, Inc./Lockwood Street Group Home Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G234

Legal name

LIFE, INC LOCKWOOD STREET GROUP HOME

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jun 11, 1992

Last certification

May 28, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

156 Countryside Road SW
Supply, NC 28462

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

CLIA laboratory certificates

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

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": "1568516938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117J VILLAGE RD NE",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284517413",
            "telephone_number": "910-371-0230",
            "fax_number": "910-799-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 COUNTRYSIDE DR SW",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284623300",
            "telephone_number": "910-754-2854",
            "fax_number": "910-799-3680"
        }
    ],
    "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-010-009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY ID",
            "identifier": "922152",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340601W",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life, Inc./Lockwood Street Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Liberty Healthcare Group LLC (Liberty Home Care , LLC)
• Liberty Healthcare Group, LLC (Liberty Home Care, LLC)
• Liberty Medical Specialties, Inc
• Liberty Nursing Services, LLC (Liberty Nursing Services)
• Life, Inc. (Life, Inc./Folly Street Group Home)
• Autumn Jean Littlebrant, LCSW
• Mark Anthony Lizak, MD
• Daniel B. Maccallum, MD
• Michelle Catherine Mackay
• Deanna England Maclaren, FNPC

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