Organization
LIFESPAN INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN DEVORE BA (VP CORPORATE COMPLIANCE/PROGRAM OPS)
(704) 944-5136
Entity
Organization
Contact information
Practice address
27 BONA VISTA DR, MARBLE, NC 28905-8646
(828) 321-9992
Mailing address
1511 SHOPTON RD, SUITE A, CHARLOTTE, NC 28217-3239
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-020-071
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020-071
—
NC
Enumeration date
04/05/2016
Last updated
01/26/2021
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