LIFESOURCE OF NORTH CAROLINA (NPI# 1801431440) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801431440 |
| Entity Type | Organization |
| Organization Name | LIFESOURCE OF NORTH CAROLINA |
| Practice Address |
1728 W 8th St Cedar Falls IA 50613-2002 |
| 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 | 2019-11-07 |
| Last Update Date | 2019-11-07 |
| 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 | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| 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 |
| 1649877762 | Lifesource of North Carolina | Psychologist | 501 2nd St, Menominee, MI 49858-3203 | 2020-10-01 |
| 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 |
| 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 |
1728 W 8TH ST |
| City | CEDAR FALLS |
| State | IA |
| Zip Code | 50613-2002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306837125 | Waverley - Cedar Falls Health Care Center, Inc. | Skilled Nursing Facility | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2005-11-01 |
| 1093171795 | Premier Estates 511, LLC | Skilled Nursing Facility | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2016-01-11 |
| 1841655560 | Diane Kremer | Physical Therapist | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2015-12-22 |
| 1154786119 | Christine Vent | Speech-Language Pathologist | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2015-12-17 |
| 1447615497 | Staci Hageman | Occupational Therapy Assistant | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2015-12-17 |
| 1346605300 | Robin Hennick | Physical Therapy Assistant | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2015-12-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699315424 | Travis Ray Turner | Pharmacist | 6301 University Ave., A3 College Square Mall, Cedar Falls, IA 50613 | 2020-01-09 |
| 1770047078 | Jake Hanson | Chiropractor | 204 W Seerley Blvd, Cedar Falls, IA 50613 | 2019-01-31 |
| 1184192577 | Payton C Stock | Student in an Organized Health Care Education/Training Program | 2250 Hudson Rd, Hpc 003, Cedar Falls, IA 50613 | 2018-11-05 |
| 1326526641 | Transcend Mind-body Wellness & Floatation Clinic LLC | Nurse Practitioner | 409 Washington St Ste D, Cedar Falls, IA 50613 | 2018-07-30 |
| 1073000444 | Shannon Lee Lindeland | Nurse Practitioner | 5100 Prairie Pkwy Ste 300, Cedar Falls, IA 50613 | 2018-04-20 |
| 1598270126 | Eastern Iowa Therapeutics P.C. | Physical Therapist | 912 Viking Road, #101, Cedar Falls, IA 50613 | 2017-12-05 |
| 1366952368 | Holahan & Boe Orthodontics, Pllc | Dentist | 1013 Hudson Road, Cedar Falls, IA 50613 | 2017-10-04 |
| 1982134870 | Shanna Lynne Elliott | Physical Therapist | 912 Viking Rd Ste 101, Cedar Falls, IA 50613 | 2017-06-14 |
| 1124476767 | Michelle Henny | Social Worker | 2616 Orchard Dr Ste B, Cedar Falls, IA 50613 | 2016-05-24 |
| 1326417478 | Rebecca Lynn Gelhaus | Dietitian, Registered | 325 Alvarado Alvarado, Cedar Falls, IA 50613 | 2015-09-18 |
| Find all providers in zip 50613 | ||||
| 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 |
|---|---|---|---|---|
| 1225684103 | Andrea Lansing, Pllc | Social Worker | 200 State St Fl 2, Cedar Falls, IA 50613-3372 | 2019-08-15 |
| 1124476767 | Michelle Henny | Social Worker | 2616 Orchard Dr Ste B, Cedar Falls, IA 50613 | 2016-05-24 |
| 1871964007 | Shantel Marie Basurto | Social Worker | 3316 Cedar Heights Dr, Suite A, Cedar Falls, IA 50613-6083 | 2015-10-14 |
| 1477953628 | Cortney Lynn Alber | Social Worker | 600 State St Ste D, Cedar Falls, IA 50613-3371 | 2014-08-25 |
| 1457983264 | Ashley Ann Gruver | Social Worker | 1824 W 8th St, Cedar Falls, IA 50613-2056 | 2020-02-10 |
| 1467801613 | Heather Andersen | Social Worker | 2802 Orchard Dr, Cedar Falls, IA 50613-5898 | 2016-06-08 |
| 1336427152 | Joyce E Riker | Social Worker | 2012 Park Dr, Cedar Falls, IA 50613-4538 | 2011-07-27 |
| 1861649311 | Diane C. Holmes | Social Worker | 324 W 3rd St, Cedar Falls, IA 50613-2745 | 2008-08-26 |
| 1568490480 | Ronald C Larson | Social Worker | 2802 Orchard Dr, Cedar Falls, IA 50613-5898 | 2006-06-29 |
| 1225066673 | John Upshaw | Social Worker | 2802 Orchard Dr, Cedar Falls, IA 50613-5898 | 2006-06-28 |
| Find all providers in CEDAR FALLS | ||||
| City | CEDAR FALLS |
| Zip Code | 50613 |
Please comment or provide details below to improve the information on LIFESOURCE OF NORTH CAROLINA.
| 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.