Look up the most recent NPI and PECOS records

Life Extensions Llc

Community/Behavioral Health

Agencies

PECOS Enrollment

Based on the most recent information from CMS, provider Life Extensions Llc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1528688678
Provider Type
Organization
Full Name
Life Extensions Llc

Subpart
No
Enumeration Date
4/19/2020
Last Updated
3/30/2022

Contact Information

Practice Location

1003 Dresser Ct, Raleigh, NC 27609-7323

(919) 532-9855

(919) 803-7231

Mailing Location

1003 Dresser Ct, Raleigh, NC 27609-7323

(919) 532-9855

(919) 803-7231

Authorized Official

Green, Stella L (Owner)

(919) 532-9855

Provider Taxonomies

Code	Description	License
Code 251S00000X Primary	Description Community/Behavioral Health Agencies	License Unlisted Issuer
Code 251B00000X	Description Case Management Agencies	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 152868867	Description Medicaid	Issuer Unlisted North Carolina
ID 1790042356	Description Medicaid	Issuer Unlisted North Carolina

Life Extensions Llc

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

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