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Organization

LIFESPAN, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. ROBIN DEVORE BA, QP (CHIEF COMPLIANCE OFFICER)
(704) 763-1887
Entity
Organization

Contact information

Practice address
601 N GRAHAM ST, CHARLOTTE, NC 28202-1439
(704) 333-7107
(704) 333-7734
Mailing address
1511 SHOPTON RD STE A, CHARLOTTE, NC 28217-3240
(704) 763-1887
(704) 944-5102

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
6055233
NC
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3408802
NC
Enumeration date
01/10/2007
Last updated
01/26/2021
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