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LIFE ST. JOSEPH OF THE PINES, INC.
NPI 1750692620
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization in Fayetteville, NC

Active since June 25, 2010CLIA 34D2016728 · Waiver
4900 RAEFORD RD, FAYETTEVILLE, NC 28304(910) 483-4911 Get Directions Write a Review

NPPES record last updated: February 8, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Life St. Joseph Of The Pines, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIFE ST. JOSEPH OF THE PINES, INC. (NPI 1750692620) is a healthcare organization registered as a program of all-inclusive care for the elderly (pace) provider organization in Fayetteville, North Carolina and active in the NPI registry since June 2010. The organization holds a CLIA Waiver certificate valid through November 22, 2026 and lists Robert Lawrence Dickson, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1750692620
Entity TypeOrganization
Primary Taxonomy251T00000X
Legal Business NameLIFE ST. JOSEPH OF THE PINES, INC.
Location Address4900 RAEFORD RDFayetteville, NC 28304-3142
Mailing Address4900 Raeford RdFayetteville, NC 28304-3142 · (910) 483-4911 · Fax (910) 483-4930
Phone(910) 483-4911
Organization SubpartYesParent: St Joseph Of The Pines
Authorized OfficialRobert Lawrence DicksonExecutive Director · (910) 429-7255
Enumeration DateJune 25, 2010
Last NPPES UpdateFebruary 8, 2013
✔ NPI 1750692620 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyProgram of All-Inclusive Care for the Elderly (PACE) Provider OrganizationAgencies
Taxonomy Code251T00000X
License✔ Licensed in NC · PENDING
Definition
A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights.
4900 RAEFORD RD, Fayetteville, NC 28304
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2016728

Life St Joseph Of The Pines · Fayetteville, NC
Active · expires Nov 22, 2026
CLIA Number34D2016728
Laboratory TypePace Program
Certificate Effective DateNovember 23, 2024
Certificate Expiration DateNovember 22, 2026
Laboratory DirectorErica Simonsen
Laboratory Phone(910) 483-4911
Laboratory LocationLife St Joseph Of The Pines4900 Raeford Road, Fayetteville, NC 28304
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KIMBERLY DAWN ZELINKA NP
Nurse Practitioner
4900 RAEFORD RD
FAYETTEVILLE, NC 28304
Cumberland County (910) 429-7229
TARA R JONES
Family Medicine
4900 RAEFORD RD
FAYETTEVILLE, NC 28304
Cumberland County (910) 429-7200
MISS MALINDA MARIE KENNISON DPT
Physical Therapist
4900 RAEFORD RD
FAYETTEVILLE, NC 28304
Cumberland County (910) 429-7239
ANN MARIE ANDERSON
Nurse Practitioner (Adult Health)
4900 RAEFORD RD
FAYETTEVILLE, NC 28304
Cumberland County (910) 429-7226
MR. DANIEL ROBERT HOWELL LRT/CTRS
Recreation Therapist
4900 RAEFORD RD
FAYETTEVILLE, NC 28304
Cumberland County (910) 429-7238

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Life St. Joseph Of The Pines, Inc.'s NPI number?

The NPI number for Life St. Joseph Of The Pines, Inc. is 1750692620. It was assigned to this organization in the NPPES registry on June 25, 2010.

Where is Life St. Joseph Of The Pines, Inc. located?

Life St. Joseph Of The Pines, Inc. is located at 4900 Raeford Rd, Fayetteville, NC 28304. The listed phone number is (910) 483-4911.

What is Life St. Joseph Of The Pines, Inc.'s specialty?

The primary specialty registered for this NPI is Program of All-Inclusive Care for the Elderly (PACE) Provider Organization with taxonomy code 251T00000X.

Does Life St. Joseph Of The Pines, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2016728) is associated with this NPI, valid through November 22, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Life St. Joseph Of The Pines, Inc. was last updated on February 8, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.