Provider Demographics
NPI:1023244860
Name:LIFE SOLUTIONS ATTENDING
Entity type:Organization
Organization Name:LIFE SOLUTIONS ATTENDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARREA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-424-0500
Mailing Address - Street 1:2018 FORT BRAGG RD
Mailing Address - Street 2:SUITE 114A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7037
Mailing Address - Country:US
Mailing Address - Phone:910-424-0500
Mailing Address - Fax:
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1512
Practice Address - Country:US
Practice Address - Phone:910-827-9524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300827BMedicaid