Organization
LIFESPAN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM STALER (CEO)
(513) 868-3210
Entity
Organization
Contact information
Practice address
1900 FAIRGROVE AVE, HAMILTON, OH 45011-1966
(513) 868-3210
(513) 868-3249
Mailing address
1900 FAIRGROVE AVE, HAMILTON, OH 45011-1966
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
35-029775
OH
251S00000X
Community/Behavioral Health Agency
E.0004344-SUPV
OH
251S00000X
Community/Behavioral Health Agency
E.0600276-SUPV
OH
251S00000X
Community/Behavioral Health Agency
E.0601020
OH
251S00000X
Community/Behavioral Health Agency
I.0003470-SUPV
OH
251S00000X
Community/Behavioral Health Agency
I.0008038SUPV
OH
251S00000X
Community/Behavioral Health Agency
Primary
I.0010181-SUPV
OH
251S00000X
Community/Behavioral Health Agency
I.1000343
OH
251S00000X
Community/Behavioral Health Agency
S.1000444
OH
251S00000X
Community/Behavioral Health Agency
S.1000832
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2864431
—
OH
Enumeration date
04/30/2012
Last updated
04/30/2012
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