Organization
LIFESPAN, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DAVAN CLONINGER (CEO/PRESIDENT)
(704) 944-5100
Entity
Organization
Contact information
Practice address
1097 PUMPKINTOWN RD, SYLVA, NC 28779-7228
(828) 631-0153
Mailing address
200 CLANTON RD, CHARLOTTE, NC 28217-1446
(704) 944-5100
(704) 944-5102
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
MHL-050-064
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408802
—
NC
Enumeration date
08/03/2015
Last updated
08/03/2015
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