Provider Demographics
NPI:1447485396
Name:LIFT DAY ACTIVITY CENTER
Entity type:Organization
Organization Name:LIFT DAY ACTIVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDEX
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-569-9566
Mailing Address - Street 1:PO BOX 1383
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-1383
Mailing Address - Country:US
Mailing Address - Phone:919-569-9566
Mailing Address - Fax:919-569-0269
Practice Address - Street 1:701 E YOUNG STREET
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571
Practice Address - Country:US
Practice Address - Phone:919-569-9566
Practice Address - Fax:919-569-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-742251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization