Organization
LIFESPAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN DEVORE (VP OF CORPORATE COMPLIANCE AND PROG)
(704) 763-1887
Entity
Organization
Contact information
Practice address
360 DUKE LODGE RD, MURPHY, NC 28906-5841
(828) 557-0975
Mailing address
1511 SHOPTON RD, SUITE A, CHARLOTTE, NC 28217-3239
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
MHL020073
NC
251S00000X
Community/Behavioral Health Agency
Primary
MHL-020-073
NC
Other
Enumeration date
06/07/2016
Last updated
09/07/2016
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