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General NPI Number Information
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NPI Number | 1184227829
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Entity Type | Organization
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Legal Business Name | THE LIFESPAN CENTER
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 293 MAIN ST
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City | YANCEYVILLE
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State | NC
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Zip | 27379-8781
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Country | US
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Telephone | 336-694-1924
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3058
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City | ROXBORO
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State | NC
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Zip | 27573-3058
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Country | US
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Telephone | 336-694-1924
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TANILLYA PARTRIDGE
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Credential | NP-C
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Telephone | 336-694-1924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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