Healthcare Provider Details

I. General information

NPI: 1114308731
Provider Name (Legal Business Name): LIFESPAN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 DURALDE HWY
EUNICE LA
70535-2131
US

IV. Provider business mailing address

1950 DURALDE HWY
EUNICE LA
70535-2131
US

V. Phone/Fax

Practice location:
  • Phone: 337-772-9946
  • Fax:
Mailing address:
  • Phone: 337-772-9946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: LISA JAUBERT
Title or Position: PRESIDENT
Credential: ANP
Phone: 337-772-9946