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General NPI Number Information
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NPI Number | 1548027451
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Entity Type | Organization
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Legal Business Name | LIFESPAN INCORPORATED
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 367 DELLWOOD RD BLDG C
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City | WAYNESVILLE
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State | NC
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Zip | 28786-3135
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Country | US
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Telephone | 704-944-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 SHOPTON RD STE A
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City | CHARLOTTE
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State | NC
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Zip | 28217-3240
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE AND QA OFFICER
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Name | ROBIN DEVORE
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Credential |
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Telephone | 704-763-1887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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