Basic Information
| Provider Information | |||||||||
| NPI: | 1144634528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE VILLAGE LIFE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9660 FALLS OF NEUSE RD STE 138 | ||||||||
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| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276152435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197238799 | ||||||||
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| Practice Location | |||||||||
| Address1: | 58155 CHINN ST STE B | ||||||||
| Address2: | |||||||||
| City: | PLAQUEMINE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707643601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253854543 | ||||||||
| FaxNumber: | 8668259703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CARR | ||||||||
| AuthorizedOfficialFirstName: | AYANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9197238799 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NC | Y | Agencies | Community/Behavioral Health |
No ID Information.