OrganizationActive
Life, Inc.
NPI 1215081021 · Intellectual Disabilities Intermediate Care Facility · Roanoke Rapids, NC
Provider details
- NPI number
- 1215081021
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Parent organization
- Life, Inc.
- Organization subpart
- Yes
- Authorized official
- Richard Smith, Vp of Business Operations(919) 778-1900
- License
- MHL-042-009 (NC)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
28 Wood Glen Rd
Roanoke Rapids, NC 27870-6285
Phone: (252) 537-4686
Fax: (252) 583-1615
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 446
Halifax, NC 27839-0446
Other names (DBA / former)
- Doing business as
- Idlewood Group Home
Registry dates
- Enumerated
- 2007-01-22
- Last updated
- 2017-12-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.