Organization
LIFESPAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN DEVORE BA (VP CORPORATE COMPLIANCE/PROGRAM OPS)
(704) 944-5100
Entity
Organization
Contact information
Practice address
291 STEWART RD, ANDREWS, NC 28901-8603
(828) 321-6034
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
MHL-020-068
NC
251S00000X
Community/Behavioral Health Agency
Primary
MHL-020-068
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408802
—
NC
Enumeration date
07/10/2015
Last updated
09/07/2016
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