Provider Demographics
NPI:1194153544
Name:LIFETOUCH HUMAN SERVICES
Entity type:Organization
Organization Name:LIFETOUCH HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:BSQP
Authorized Official - Phone:336-887-9504
Mailing Address - Street 1:414 OTTERAY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-2918
Mailing Address - Country:US
Mailing Address - Phone:336-887-9504
Mailing Address - Fax:
Practice Address - Street 1:414 OTTERAY AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-2918
Practice Address - Country:US
Practice Address - Phone:336-887-9504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities