Provider Demographics
NPI:1134306814
Name:THE SIMPLE LIFE SERVICES, INC
Entity Type:Organization
Organization Name:THE SIMPLE LIFE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRILL
Authorized Official - Middle Name:CORELLY
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:BS BUSINESS ADMINIST
Authorized Official - Phone:704-868-8328
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-1195
Mailing Address - Country:US
Mailing Address - Phone:704-868-8328
Mailing Address - Fax:704-868-8332
Practice Address - Street 1:520 UNION RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4450
Practice Address - Country:US
Practice Address - Phone:704-868-8328
Practice Address - Fax:704-868-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300821BMedicaid