NPIMap

Organization Active NPI

Life, Inc.

  • Adult Care Home Facility
  • Edenton, NC
National Provider Identifier
1760522478
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
MHL-021-013 Issued in NC
Legal business name
LIFE, INC.
Doing business as
Luke Street Facility - Edenton
Practice address
200 Luke St
Edenton, NC 27932-9614
Phone
(919) 734-4386
NPI assigned
Feb 8, 2007
Organization subpart
Yes
Parent organization
LIFE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Walker
Title
Director of Contract Services
Phone
(919) 778-1900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X MHL-021-013 NC Primary
Non-emergency Medical Transport (VAN) 343900000X MHL-021-013 NC

Addresses

Primary practice location

200 Luke St
Edenton, NC 27932-9614

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
MHL-021-013MedicaidNC

Other names 1

  • Luke Street Facility - Edenton 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

200 Luke St
Edenton, NC 27932
Phone (919) 734-4386

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1760522478",
    "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": "200 LUKE ST",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279329614",
            "telephone_number": "919-734-4386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE, INC.",
        "enumeration_date": "2007-02-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACT SERVICES",
        "authorized_official_telephone_number": "919-778-1900"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-021-013",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "NC",
            "license": "MHL-021-013",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MHL-021-013",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Luke Street Facility - Edenton",
            "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 Jul 21, 2022; 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.