Healthcare Provider Details

I. General information

NPI: 1326611187
Provider Name (Legal Business Name): LIFESPRING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 VINCENNES ST
NEW ALBANY IN
47150-3148
US

IV. Provider business mailing address

460 SPRING ST
JEFFERSONVILLE IN
47130-3452
US

V. Phone/Fax

Practice location:
  • Phone: 812-280-2080
  • Fax:
Mailing address:
  • Phone: 812-280-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ANNE KEENEY
Title or Position: EVP COMMUNITY HEALTH INITIATIVES
Credential: DRPH
Phone: 812-206-1362