Organization
LIFESPAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN DEVORE (VP CORPORATE COMPLIANCE AND PROGRAM)
(704) 944-5100
Entity
Organization
Contact information
Practice address
31 JAMES ST, BREVARD, NC 28712-3779
(704) 944-5100
Mailing address
1511 SHOPTON RD, SUITE A, CHARLOTTE, NC 28217-3239
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL088036
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408802
—
NC
Enumeration date
12/28/2016
Last updated
12/28/2016
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