Provider Demographics
NPI:1417154972
Name:PHASES OF LIFE
Entity Type:Organization
Organization Name:PHASES OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-691-0800
Mailing Address - Street 1:123 SLATEWORTH DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6183
Mailing Address - Country:US
Mailing Address - Phone:919-638-5141
Mailing Address - Fax:
Practice Address - Street 1:123 SLATEWORTH DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6183
Practice Address - Country:US
Practice Address - Phone:919-638-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services