NPIMap

Organization Active NPI

Life, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Goldsboro, NC
National Provider Identifier
1750435111
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-096-003 Issued in NC
Legal business name
LIFE, INC.
Practice address
407 N William St
Goldsboro, NC 27530-2801
Phone
(919) 734-1402
Fax
(919) 583-8210
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-096-003 NC Primary

Addresses

Primary practice location

407 N William St
Goldsboro, NC 27530-2801

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
3416319MedicaidNC
922100OtherNCSTATE FACILITY ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G028

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LIFE, INC WILLIAM STREET HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Apr 2, 1985
Last certification
Jul 15, 2025
Beds
6
Ownership / control type
Private (proprietary)
Most recent change of ownership
Dec 3, 2019
Facility address
407 North William Street
Goldsboro, NC 27530

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": "1750435111",
    "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": "407 N WILLIAM ST",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275302801",
            "telephone_number": "919-734-1402",
            "fax_number": "919-583-8210"
        }
    ],
    "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-096-003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3416319",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY ID",
            "identifier": "922100",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

Verify at the official NPI Registry.