Provider Demographics
NPI:1578184594
Name:LIFE-WAY HOMES, LLC
Entity type:Organization
Organization Name:LIFE-WAY HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, FNP, DNP
Authorized Official - Phone:301-257-0640
Mailing Address - Street 1:1 BUFFALO AVE NW STE 201
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4004
Mailing Address - Country:US
Mailing Address - Phone:980-859-2230
Mailing Address - Fax:
Practice Address - Street 1:7919 MOSSYCUP DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7159
Practice Address - Country:US
Practice Address - Phone:301-257-0640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness