Organization
LIFESPAN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROBIN DEVORE BA (CHIEF COMPLIANCE OFFICER)
(704) 944-5100
Entity
Organization
Contact information
Practice address
919 STOKES ST, BURLINGTON, NC 27215-6537
(336) 513-4250
(336) 513-4241
Mailing address
1511 SHOPTON RD, SUITE A, CHARLOTTE, NC 28217-3239
(704) 944-5100
(704) 944-5102
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
01000441
NC
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
01000441
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408802
—
NC
Enumeration date
01/10/2007
Last updated
08/31/2021
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