Healthcare Provider Details

I. General information

NPI: 1750217261
Provider Name (Legal Business Name): LIFESPAN SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 TRINITY DR W
WILSON NC
27893-2128
US

IV. Provider business mailing address

6622 BRIGHTON PARK DR
MINT HILL NC
28227-7875
US

V. Phone/Fax

Practice location:
  • Phone: 704-907-3422
  • Fax:
Mailing address:
  • Phone: 704-907-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. DEANNA SMITH
Title or Position: OWNER
Credential:
Phone: 704-907-3422