MEDICARE: LIFESPAN CARE MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	RN201503L	PA
2	251B00000X	Case Management Agency	26NR06230700	NJ

General Provider Information

NPI Number	:	1629394606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESPAN CARE MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	200 FEDERAL ST
Second Line	:	SUITE 225
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1061
Country	:	US
Telephone Number	:	856-479-9045
Fax Number	:	856-795-1297

Provider Business Practice Location Address
First Line	:	200 FEDERAL ST
Second Line	:	SUITE 225
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1061
Country	:	US
Telephone Number	:	856-479-9045
Fax Number	:	856-795-1297

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL NEWELL
Credential	:	RN MSN
Telephone Number	:	856-479-9045

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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