=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770460958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFESPAN HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2025
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 W MARION AVE
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44507-1042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-599-3525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 W MARION AVE
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44507-1042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-599-3525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ROSCOE COLIN THURSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-599-3525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------