Healthcare Provider Details

I. General information

NPI: 1366654154
Provider Name (Legal Business Name): LIFESPIRE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 PLIMPTON AVE
BRONX NY
10452-2702
US

IV. Provider business mailing address

462 FASHION AVE FL 5
NEW YORK NY
10018-7852
US

V. Phone/Fax

Practice location:
  • Phone: 212-529-0170
  • Fax:
Mailing address:
  • Phone: 212-741-0100
  • Fax: 212-320-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number6136442
License Number StateNY

VIII. Authorized Official

Name: EMILIO BONILLA
Title or Position: CFO
Credential:
Phone: 212-741-0100