ECHO FARMS GROUP HOME (LIFETIME RESOURCES, INC.) NPI 1003021874

Intermediate Care Facility, Mentally Retarded in Wilmington, NC

NPI 1003021874 Organization Intermediate Care Facility, Mentally Ret... CLIA Number 34D2130290 CLIA Certificate of Waiver

NPI Profile for ECHO FARMS GROUP HOME (LIFETIME RESOURCES, INC.)

Echo Farms Group Home (lifetime Resources, Inc.) is a provider established in Wilmington, North Carolina specializing in intermediate care facility, mentally retarded. The NPI number of Echo Farms Group Home (lifetime Resources, Inc.) is 1003021874 and was assigned on May 2007. The practitioner's primary taxonomy code is 315P00000X with license number 3406452 (NC). The provider is registered as an organization and their NPI record was last updated 5 years ago. The provider's other name is Echo Farms Group Home. The authorized official of this NPI record is Dr. Robert T. Thacker, Jr. Ph.d. (Executive Director)

The CLIA number of Echo Farms Group Home is 34D2130290 registered as a "intermediate care facility/individuals with intellectual disability" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Echo Farms Group Home to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1003021874

Provider NameECHO FARMS GROUP HOME (LIFETIME RESOURCES, INC.)
Provider Location Address220 DORCHESTER PL WILMINGTON, NC 28412
Provider Mailing Address1316 S. 16TH STREET WILMINGTON, NC 28401
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameECHO FARMS GROUP HOME
Other Name TypeOther Name (5)
Enumeration Date05-14-2007
Last Update Date07-07-2017


Primary Taxonomy

Taxonomy Code315P00000X
ClassificationIntermediate Care Facility, Mentally Retarded
TypeNursing & Custodial Care Facilities
License No.3406452
License StateNC
Taxonomy Description(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.

Business Address

ECHO FARMS GROUP HOME
220 DORCHESTER PL
WILMINGTON, NC
ZIP 28412
Phone: (910) 762-1189
Fax: (910) 762-1301

Get Directions


Mailing Address

ECHO FARMS GROUP HOME
1316 S. 16TH STREET
WILMINGTON, NC
ZIP 28401
Phone: (910) 762-1189
Fax: (910) 762-1301



Authorized Official

Authorized Official NameDR. ROBERT T. THACKER, JR. PH.D.
Authorized Official TitleEXECUTIVE DIRECTOR
Authorized Official Phone(910) 762-1189

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003021874 is:

CLIA Number34D2130290
Facility TypeINTERMEDIATE CARE FACILITY/INDIVIDUALS WITH INTELLECTUAL DISABILITY
Certificate TypeCertificate of Waiver

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities3406452NCNo

Taxonomy Description: a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
3406452MEDICAID (05)NC

NPI Validation Check Digit Calculation


The following table explains step by step the NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1003021874
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2003022814
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 0 + 3 + 0 + 2 + 2 + 8 + 1 + 4 + 24 = 46
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 46 = 44

The NPI number 1003021874 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Echo Farms Group Home is registered as an entity type code: 2. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.