Healthcare Provider Details

I. General information

NPI: 1093041576
Provider Name (Legal Business Name): LIFESPAN...A COMMUNITY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 LANSING AVE
JACKSON MI
49201-2804
US

IV. Provider business mailing address

524 LANSING AVE
JACKSON MI
49201-2804
US

V. Phone/Fax

Practice location:
  • Phone: 517-817-0096
  • Fax: 517-789-7883
Mailing address:
  • Phone: 517-817-0096
  • Fax: 517-789-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA FREYSINGER
Title or Position: CEO
Credential:
Phone: 517-784-4426