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Organization

LIFESPAN, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. LEIGH DERBY MS (CEO)
(704) 944-5100
Entity
Organization

Contact information

Practice address
1203 CREEK DR, WILKESBORO, NC 28697-8678
(336) 667-5001
(336) 667-5047
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
MHL-097-051
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3408802
NC
Enumeration date
01/05/2007
Last updated
08/22/2020
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