Provider Demographics
NPI:1760188072
Name:LIFE NET SERVICES
Entity Type:Organization
Organization Name:LIFE NET SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABBAGESTALK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-745-8895
Mailing Address - Street 1:PO BOX 87024
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7024
Mailing Address - Country:US
Mailing Address - Phone:910-745-8895
Mailing Address - Fax:
Practice Address - Street 1:711 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-5211
Practice Address - Country:US
Practice Address - Phone:910-745-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness