Organization
LIFESPAN INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN DEVORE (VP CORPORATE COMPLIANCE AND OPERATI)
(704) 944-5100
Entity
Organization
Contact information
Practice address
3529 HATWYNN RD, CHARLOTTE, NC 28269-1329
(704) 944-5100
Mailing address
1511 SHOPTON RD STE A, CHARLOTTE, NC 28217-3240
(704) 763-1887
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
348802
—
NC
Enumeration date
04/17/2018
Last updated
06/16/2018
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