Provider Demographics
NPI:1881715548
Name:THE LIFE CENTER OF DAVIDSON COUNTY, INC.
Entity type:Organization
Organization Name:THE LIFE CENTER OF DAVIDSON COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:RUMMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-249-2155
Mailing Address - Street 1:601 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-2715
Mailing Address - Country:US
Mailing Address - Phone:336-249-2155
Mailing Address - Fax:336-249-2374
Practice Address - Street 1:601 W CENTER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-2715
Practice Address - Country:US
Practice Address - Phone:336-249-2155
Practice Address - Fax:336-249-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409162Medicaid