Provider Demographics
NPI:1972188100
Name:JL MASTERLIFE INC.
Entity Type:Organization
Organization Name:JL MASTERLIFE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-486-8685
Mailing Address - Street 1:100 N BROAD ST # 89
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1988
Mailing Address - Country:US
Mailing Address - Phone:252-486-8685
Mailing Address - Fax:
Practice Address - Street 1:1036 YEOPIM RD
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9417
Practice Address - Country:US
Practice Address - Phone:252-486-8685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home