Organization
LIFESPAN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DAVAN CLONINGER BA, MS (CEO/PRESIDENT)
(704) 944-5100
Entity
Organization
Contact information
Practice address
130 WILLIAMSON AVE, MOUNT AIRY, NC 27030-5156
(336) 783-0829
(336) 783-4754
Mailing address
200 CLANTON RD, CHARLOTTE, NC 28217-1304
(704) 944-5100
(704) 944-5102
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
86000192
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408802
—
NC
Enumeration date
01/10/2007
Last updated
06/03/2013
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