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General NPI Number Information
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NPI Number | 1215910872
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Entity Type | Organization
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Legal Business Name | LIFESPACE COMMUNITIES INC
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 401 E LINTON BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33483-5028
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Country | US
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Telephone | 561-272-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 401 E LINTON BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33483-5028
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Country | US
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Telephone | 561-272-7979
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. SCOTT HARRISON
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Credential |
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Telephone | 515-288-5805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1195096
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License Number State | FL
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