Provider Demographics
NPI:1770769721
Name:LIFE STAGES INTEGRATED SERVICES, LLC
Entity type:Organization
Organization Name:LIFE STAGES INTEGRATED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSCOE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-327-4231
Mailing Address - Street 1:2407 GRACE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-4416
Mailing Address - Country:US
Mailing Address - Phone:252-327-4231
Mailing Address - Fax:252-355-7287
Practice Address - Street 1:2407 GRACE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4416
Practice Address - Country:US
Practice Address - Phone:252-327-4231
Practice Address - Fax:252-355-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management