Healthcare Provider Details

I. General information

NPI: 1215910872
Provider Name (Legal Business Name): LIFESPACE COMMUNITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E LINTON BLVD
DELRAY BEACH FL
33483-5028
US

IV. Provider business mailing address

401 E LINTON BLVD
DELRAY BEACH FL
33483-5028
US

V. Phone/Fax

Practice location:
  • Phone: 561-272-7979
  • Fax:
Mailing address:
  • Phone: 561-272-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1195096
License Number StateFL

VIII. Authorized Official

Name: MR. SCOTT HARRISON
Title or Position: PRESIDENT & CEO
Credential:
Phone: 515-288-5805