Provider Demographics
NPI:1952599110
Name:LIFE SUPPORT OF THE PIEDMONT
Entity Type:Organization
Organization Name:LIFE SUPPORT OF THE PIEDMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSLYNN
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-420-0188
Mailing Address - Street 1:PO BOX 6657
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-6657
Mailing Address - Country:US
Mailing Address - Phone:336-420-0188
Mailing Address - Fax:
Practice Address - Street 1:175 NORTHPOINT AVE
Practice Address - Street 2:SUITE #111- B
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7737
Practice Address - Country:US
Practice Address - Phone:336-420-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health