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General NPI Number Information
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NPI Number | 1578500443
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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 | 06/01/2006
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 515 VILLAGE PL
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City | LONGWOOD
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State | FL
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Zip | 32779-6041
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Country | US
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Telephone | 407-682-0230
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Fax | 407-682-3893
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Provider Business Mailing Address
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Address Line | 515 VILLAGE PL
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City | LONGWOOD
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State | FL
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Zip | 32779-6041
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Country | US
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Telephone | 407-682-0230
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Fax | 407-682-3893
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. JESSE JANTZEN
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 21234096
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1579096
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License Number State | FL
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