Organization
LIFESPAN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN DEVORE BA (VP CORPORATE COMPLIANCE/PROGRAM OPS)
(704) 944-5100
Entity
Organization
Contact information
Practice address
302 W BROAD ST, STATESVILLE, NC 28677-5260
(704) 872-8579
(704) 872-5272
Mailing address
1511 SHOPTON RD, SUITE A, CHARLOTTE, NC 28217-3239
(704) 944-5100
(704) 944-5102
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
49000254
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408802
—
NC
Enumeration date
01/10/2007
Last updated
11/04/2016
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