Provider Demographics
NPI:1811228042
Name:LIFE OPPORTUNITIES THERAPEUTIC HOME SERVICES LLC
Entity Type:Organization
Organization Name:LIFE OPPORTUNITIES THERAPEUTIC HOME SERVICES LLC
Other - Org Name:LIFE OPPORTUNITIES BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-843-1105
Mailing Address - Street 1:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0773
Mailing Address - Country:US
Mailing Address - Phone:910-843-1105
Mailing Address - Fax:910-843-1295
Practice Address - Street 1:129 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1428
Practice Address - Country:US
Practice Address - Phone:910-843-1105
Practice Address - Fax:910-843-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NC253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health