Healthcare Provider Details

I. General information

NPI: 1750337663
Provider Name (Legal Business Name): LIFESPACE COMMUNITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 LOWSON BLVD
DELRAY BEACH FL
33445-6008
US

IV. Provider business mailing address

2000 LOWSON BLVD
DELRAY BEACH FL
33445-6008
US

V. Phone/Fax

Practice location:
  • Phone: 561-454-2007
  • Fax: 561-454-2033
Mailing address:
  • Phone: 561-454-2007
  • Fax: 561-454-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1201096
License Number StateFL

VIII. Authorized Official

Name: SCOTT HARRISON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 515-288-5805