NPIMap

Organization Active NPI

Life, Inc.

  • Adult Care Home Facility
  • Hertford, NC
National Provider Identifier
1962542837
Registry record updated Dec 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
MHL-072-007 Issued in NC
Legal business name
LIFE, INC.
Practice address
142 Riverwood Dr
Hertford, NC 27944-9784
Phone
(919) 778-1900
NPI assigned
Feb 8, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X MHL-072-007 NC Primary
Non-emergency Medical Transport (VAN) 343900000X MHL-072-007 NC

Addresses

Primary practice location

142 Riverwood Dr
Hertford, NC 27944-9784

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7805690MedicaidNC

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

142 Riverwood Dr
Hertford, NC 27944
Phone (919) 778-1900

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": "1513296000000",
    "number": "1962542837",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 RIVERWOOD DR",
            "city": "HERTFORD",
            "state": "NC",
            "postal_code": "279449784",
            "telephone_number": "919-778-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE, INC.",
        "enumeration_date": "2007-02-08",
        "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": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-072-007",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "NC",
            "license": "MHL-072-007",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805690",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hertford, 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.