LIFESOURCE OF NORTH CAROLINA (NPI# 1649877762) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649877762 |
| Entity Type | Organization |
| Organization Name | LIFESOURCE OF NORTH CAROLINA |
| Practice Address |
501 2nd St Menominee MI 49858-3203 |
| Mailing Address |
Po Box 538622 Atlanta GA 30353-8622 |
| Practice Telephone | 9107429243 |
| Practice Fax Number | 8887461787 |
| Mailing Telephone | 9107429243 |
| Mailing Fax Number | 8887461787 |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |
| Authorized Official Name | PEGGY BADDOUR (PRESIDENT) |
| Authorized Official Telephone | 9105351211 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497378848 | Lifesource of North Carolina | Psychologist | 8315 Zimpel St, New Orleans, LA 70118-1169 | 2020-05-20 |
| 1972131308 | Lifesource of North Carolina | Psychologist | 140 Park Ave, Bloomfield, CT 06002-3207 | 2020-03-31 |
| 1619515277 | Lifesource of North Carolina | Psychologist | 204 W Main St, New London, OH 44851-1070 | 2019-12-13 |
| 1801431127 | Lifesource of North Carolina | Psychologist | 725 2nd Ave S, Hopkins, MN 55343-7782 | 2019-11-11 |
| 1174168496 | Lifesource of North Carolina | Psychologist | 600 Main St S, Minot, ND 58701-4499 | 2019-11-11 |
| 1801431440 | Lifesource of North Carolina | Psychologist | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2019-11-07 |
| 1093350647 | Lifesource of North Carolina | Psychologist | 2900 W E St, North Platte, NE 69101-1803 | 2019-11-07 |
| 1871135723 | Lifesource of North Carolina | Psychologist | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2019-10-11 |
| 1538728183 | Lifesource of North Carolina | Psychologist | 200 Nursing Home Ln, Pikeville, KY 41501-6896 | 2019-06-07 |
| 1730648288 | Lifesource of North Carolina | Social Worker | 5530 Northrop Rd, Milton, FL 32570-8701 | 2019-03-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | LifeSource of North Carolina Inc. | 5617 Maxwell Place, Wilmington, North Carolina 28408 |
| Alabama Business Registrations | LifeSource of North Carolina, Inc. | 5617 Maxwell Place, Wilmington, NC 28409 |
| Street Address |
501 2ND ST |
| City | MENOMINEE |
| State | MI |
| Zip Code | 49858-3203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285627422 | Rice Health Care Facilities Inc | Skilled Nursing Facility | 501 2nd St, Menominee, MI 49858-3203 | 2005-08-23 |
| 1013557701 | Joy Zamzow | Occupational Therapist | 501 2nd St, Menominee, MI 49858-3203 | 2020-01-09 |
| 1275176133 | Nsh Menominee LLC | Skilled Nursing Facility | 501 2nd St, Menominee, MI 49858-3203 | 2019-10-23 |
| 1477083442 | Menominee Care Center, LLC | Skilled Nursing Facility | 501 2nd St, Menominee, MI 49858-3203 | 2017-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942843800 | Lynnette Marie Geib | Technician | N1872 Hwy M-35, Menominee, MI 49858 | 2019-10-23 |
| 1669955514 | Corrina Rae Anderson | Behavior Technician | 1104 16th Ave, Menominee, MI 49858 | 2018-09-06 |
| 1740668565 | Eyecare Services, LLC | Voluntary or Charitable | 3400 North 10th St #73, Menominee, MI 49858 | 2015-05-13 |
| 1922300714 | Great Lakes Recovery Centers, Inc. | Community/Behavioral Health | 3120 10th Street, Suite 2, Menominee, MI 49858 | 2010-11-30 |
| 1295043651 | Andrew John Thanos | Dentist | 1201 10th Street, Menominee, MI 49858 | 2010-09-20 |
| 1962645226 | Mack Occupational Health Services Sc | General Practice | N528 Fairland Island, Menominee, MI 49858 | 2009-04-15 |
| 1194901686 | Bonnie Susan Pulkowski | Nurse Practitioner | 1110 10th Ave Ste 101, Menominee, MI 49858 | 2008-01-14 |
| 1740383207 | Troy R Clausen | Dentist | N166 West Dr, Menominee, MI 49858 | 2006-09-07 |
| 1750483095 | George Swift Harris | Dentist | 2012 10th St, Menominee, MI 49858 | 2006-09-05 |
| 1316912397 | John Owens Beldo | Dentist | 2108 22nd Ave, Menominee, MI 49858 | 2006-02-22 |
| Find all providers in zip 49858 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306976840 | Geralyn Ann Hall | Social Worker | 1110 10th Ave Ste L4, Menominee, MI 49858-3058 | 2007-03-06 |
| 1154436970 | Gilbert E Garcia | Social Worker | 3612 13th St, Menominee, MI 49858-1520 | 2006-08-20 |
| 1750924460 | Jennifer Pastorick | Social Worker | 401 10th Ave, Menominee, MI 49858-3009 | 2019-10-25 |
| 1144872235 | Cassandra Barron | Social Worker | 401 10th Ave, Menominee, MI 49858-3009 | 2019-07-10 |
| 1326519877 | Sarah Walloch | Social Worker | 401 10th Ave, Menominee, MI 49858-3009 | 2018-12-10 |
| 1295219343 | Nkechi Okeafor | Social Worker | 401 10th Ave, Menominee, MI 49858-3009 | 2018-09-24 |
| 1750890786 | Z Boost Performance | Social Worker | 1110 10th Ave Ste L4, Menominee, MI 49858-3058 | 2017-09-21 |
| 1528597572 | Courtney Jukkala | Social Worker | 401 10th Ave, Menominee, MI 49858-3009 | 2017-06-05 |
| 1568808327 | Stephanie Ann Nelson | Social Worker | 401 10th Ave, Menominee, MI 49858-3009 | 2013-05-20 |
| 1093158107 | Erin E Beckman | Social Worker | 401 10th Ave, Menominee, MI 49858-3009 | 2013-04-09 |
| Find all providers in MENOMINEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.