Provider Demographics
NPI:1164736138
Name:ADVOCATES FOR LIFE FOUNDATION
Entity Type:Organization
Organization Name:ADVOCATES FOR LIFE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMELIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:BS,QP
Authorized Official - Phone:910-805-7802
Mailing Address - Street 1:803 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9622
Mailing Address - Country:US
Mailing Address - Phone:910-805-7802
Mailing Address - Fax:
Practice Address - Street 1:803 SAVANNAH DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-9622
Practice Address - Country:US
Practice Address - Phone:910-805-7802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC320900000XMedicaid
NC251S00000XMedicaid
NC320800000XMedicaid
NC251B00000XMedicaid
NC251C00000XMedicaid
NC252Y00000XMedicaid