Provider Demographics
NPI:1316265614
Name:SPRING LIFE BEHAVIORAL CARE LLC
Entity type:Organization
Organization Name:SPRING LIFE BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHISOM
Authorized Official - Middle Name:
Authorized Official - Last Name:ATUFUNWA
Authorized Official - Suffix:
Authorized Official - Credentials:BS,
Authorized Official - Phone:919-451-1618
Mailing Address - Street 1:200 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3134
Mailing Address - Country:US
Mailing Address - Phone:252-535-6400
Mailing Address - Fax:252-535-6401
Practice Address - Street 1:109 LONG CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3162
Practice Address - Country:US
Practice Address - Phone:252-535-6400
Practice Address - Fax:252-535-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)