Provider Demographics
NPI:1245589076
Name:LIFE MATTERS CENTERS FOR HOPE, HEALTH AND HEALING
Entity Type:Organization
Organization Name:LIFE MATTERS CENTERS FOR HOPE, HEALTH AND HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEARLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-483-7068
Mailing Address - Street 1:P.O. BOX 9532
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311
Mailing Address - Country:US
Mailing Address - Phone:910-483-7068
Mailing Address - Fax:
Practice Address - Street 1:408 WADDELL DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-483-7068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007495Medicaid
NC6007495Medicaid