Provider Demographics
NPI:1821100942
Name:LIFE ALLIANCE, LLC
Entity Type:Organization
Organization Name:LIFE ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-957-7250
Mailing Address - Street 1:379 WHISPERING PINES RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-9215
Mailing Address - Country:US
Mailing Address - Phone:336-957-7250
Mailing Address - Fax:336-838-5449
Practice Address - Street 1:967 SPARTA RD
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-8090
Practice Address - Country:US
Practice Address - Phone:336-838-5229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409663Medicaid