Healthcare Provider Details

I. General information

NPI: 1033157607
Provider Name (Legal Business Name): LIFESPACE COMMUNITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 UNIVERSE BLVD
JUNO BEACH FL
33408-2444
US

IV. Provider business mailing address

601 UNIVERSE BLVD
JUNO BEACH FL
33408-2444
US

V. Phone/Fax

Practice location:
  • Phone: 561-627-3800
  • Fax: 561-694-0242
Mailing address:
  • Phone: 561-627-3800
  • Fax: 561-694-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number21181096
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1587096
License Number StateFL

VIII. Authorized Official

Name: JODI HIRSCH
Title or Position: SVP & GENERAL COUNSEL
Credential:
Phone: 515-288-5805