Organization
LIFESPAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN DEVORE (CHIEF COMPLIANCE OFFICER)
(704) 763-1887
Entity
Organization
Contact information
Practice address
1669 HENDRIX RD, MURPHY, NC 28906-3664
(828) 321-9992
Mailing address
1511 SHOPTON RD STE A, CHARLOTTE, NC 28217-3240
(704) 763-1887
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408802
—
NC
Enumeration date
01/21/2020
Last updated
01/21/2020
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