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NPI Code Detail

MEDICARE: LIFESPAN, INC

MEDICARE: LIFESPAN, INC
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
1251S00000XCommunity/Behavioral Health AgencyS.1000444OH
2251S00000XCommunity/Behavioral Health AgencyI.0003470-SUPVOH
3251S00000XCommunity/Behavioral Health AgencyE.0004344-SUPVOH
4251S00000XCommunity/Behavioral Health AgencyS.1000832OH
5251S00000XCommunity/Behavioral Health Agency35-029775OH
6251S00000XCommunity/Behavioral Health AgencyI.1000343OH
7251S00000XCommunity/Behavioral Health AgencyE.0601020OH
8251S00000XCommunity/Behavioral Health AgencyE.0600276-SUPVOH
9251S00000XCommunity/Behavioral Health AgencyI.0008038SUPVOH
10251S00000XCommunity/Behavioral Health AgencyI.0010181-SUPVOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750649521
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFESPAN, INC
Provider Business Mailing Address
First Line : 1900 FAIRGROVE AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45011-1966
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1900 FAIRGROVE AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45011-1966
Country : US
Telephone Number : 513-868-3210
Fax Number : 513-868-3249
Authorized Official
Title or Position : CEO
Name : MR. WILLIAM STALER
Credential :
Telephone Number : 513-868-3210
Provider Enumeration Date : 04/30/2012
Last Update Date : 04/30/2012

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Directions to “LIFESPAN, INC ” Practice Location

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