Provider Demographics
NPI:1831364306
Name:LIFE BASED CONCEPTIONS LLC
Entity type:Organization
Organization Name:LIFE BASED CONCEPTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:GILES
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MHQP
Authorized Official - Phone:919-403-6160
Mailing Address - Street 1:1415 W NC HIGHWAY 54
Mailing Address - Street 2:STE 209
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5577
Mailing Address - Country:US
Mailing Address - Phone:919-403-6160
Mailing Address - Fax:919-640-8810
Practice Address - Street 1:1415 W NC HWY
Practice Address - Street 2:STE 209
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5578
Practice Address - Country:US
Practice Address - Phone:919-403-6160
Practice Address - Fax:919-640-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services