LIFESPAN, INC. (NPI# 1619013695) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619013695 |
| Entity Type | Organization |
| Organization Name | LIFESPAN, INC. |
| Practice Address |
628 Flowe Dr Charlotte NC 28213-5607 |
| Mailing Address |
1511 Shopton Rd Suite A Charlotte NC 28217-3239 |
| Practice Telephone | 7045986002 |
| Practice Fax Number | 7049445102 |
| Mailing Telephone | 7049445100 |
| Mailing Fax Number | 7049445102 |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2018-11-05 |
| Authorized Official Name | MS. ROBIN DEVORE (VP CORPORATE COMPLIANCE/PROGRAM OPS) |
| Authorized Official Telephone | 7049445100 |
| Authorized Official Credential | BA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | MHL-060-150 | NC | Residential Treatment Facilities |
| N | 251C00000X | Day Training, Developmentally Disabled Services | MHL-060-150 | NC | Agencies |
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 3408802 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962924381 | Lifespan, Inc. | Case Management | 314 E 8th Ave, Homestead, PA 15120-1518 | 2017-07-07 |
| 1598950719 | Lifespan, Inc. | Day Training, Developmentally Disabled Services | 20 Harmon Cir, Asheville, NC 28803-1318 | 2007-09-11 |
| 1649317850 | Lifespan, Inc. | Day Training, Developmentally Disabled Services | 67 Redbud Ln, Waynesville, NC 28786-5640 | 2007-01-30 |
| 1730226945 | Lifespan, Inc. | Day Training, Developmentally Disabled Services | 147 Iredell Ave, Troutman, NC 28166-9511 | 2007-01-30 |
| 1841336112 | Lifespan, Inc. | Day Training, Developmentally Disabled Services | 5400 Tuckaseegee Rd, Charlotte, NC 28208-2522 | 2007-01-30 |
| 1447396098 | Lifespan, Inc. | Day Training, Developmentally Disabled Services | 222 Hidden Forrest Ln, Hayesville, NC 28904-6502 | 2007-01-30 |
| 1285770230 | Lifespan, Inc. | Day Training, Developmentally Disabled Services | 3747 Bon Rea Dr, Charlotte, NC 28226-3149 | 2007-01-29 |
| 1457400194 | Lifespan, Inc. | Day Training, Developmentally Disabled Services | 919 Stokes St, Burlington, NC 27215-6537 | 2007-01-10 |
| 1003965781 | Lifespan, Inc. | Day Training, Developmentally Disabled Services | 302 W Broad St, Statesville, NC 28677-5260 | 2007-01-10 |
| 1326197062 | Lifespan, Inc. | Day Training, Developmentally Disabled Services | 130 Williamson Ave, Mount Airy, NC 27030-5156 | 2007-01-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | LIFESPAN, INC. | 800 Bell Trace Circle, Bloomington, IN 47408 |
| Street Address |
628 FLOWE DR |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28213-5607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194288241 | Tonya Denise Farmer | Nurse Practitioner | 620 Tom Hunter Road, Charlotte, NC 28213 | 2019-04-06 |
| 1447743331 | April Neville | Counselor | 2442 Ryerson Ct, Charlotte, NC 28213 | 2018-06-14 |
| 1194234328 | Specialized Health Care Services | Case Management | 2750 E. Wt Harris Blvd, Suite 128, Charlotte, NC 28213 | 2017-09-19 |
| 1871016816 | Monarch | Occupational Therapist | 1810 Back Creek Drive, Charlotte, NC 28213 | 2017-07-21 |
| 1609306778 | Mackenzie Cashman Precht | Physician Assistant | 2225 E W T Harris Blvd Unit B, Charlotte, NC 28213 | 2017-06-12 |
| 1861939118 | Nensi Pandya | Pharmacist | 10227 University City Blvd, Charlotte, NC 28213 | 2017-01-25 |
| 1952721458 | Morgan Washington | Specialist/Technologist | 2336 Comfrey Court, Charlotte, NC 28213 | 2014-04-23 |
| 1992132393 | Midway Healthcare | Home Health | 6003 Dovetree Lane Suite D, Charlotte, NC 28213 | 2013-09-30 |
| 1932445178 | Zachary Gachogu Kariuki | Counselor | 10417 Round Leaf Drive, Charlotte, NC 28213 | 2012-12-17 |
| 1962747675 | Crystal Cherie Simmons | Counselor | 13724 Riding Hill Ave, Charlotte, NC 28213 | 2012-12-06 |
| Find all providers in zip 28213 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811517774 | Educare Community Living Corporation-north Carolina | Intermediate Care Facility, Mentally Retarded | 834 Tyvola Rd Ste 116, Charlotte, NC 28217-3542 | 2020-04-21 |
| 1861822314 | Voca Corporation of North Carolina | Intermediate Care Facility, Mentally Retarded | 4109 Enoch Dr, Charlotte, NC 28269-2578 | 2013-11-20 |
| 1770827552 | Educare Community Living Corporation - North Carolina | Intermediate Care Facility, Mentally Retarded | 8205 Browne Rd., Charlotte, NC 28217 | 2012-11-19 |
| 1063764702 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 5917 Rowan Way, Charlotte, NC 28214 | 2012-10-04 |
| 1972854693 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 4319 Mantle Ct, Charlotte, NC 28205-7243 | 2012-09-20 |
| 1093066714 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 4400 Dalmoor Dr, Charlotte, NC 28212-2157 | 2012-09-20 |
| 1043561764 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 1123 Ravendale Dr, Charlotte, NC 28216-1526 | 2012-09-20 |
| 1255451233 | Voca Corporation of North Carolina, Inc. | Intermediate Care Facility, Mentally Retarded | 5416 Oak Dr, Charlotte, NC 28216-2645 | 2007-03-31 |
| 1972623957 | Voca Corporation of North Carolina, Inc. | Intermediate Care Facility, Mentally Retarded | 1615 Purser Dr, Charlotte, NC 28215-2934 | 2007-03-31 |
| 1598885584 | Voca Corporation of North Carolina, Inc. | Intermediate Care Facility, Mentally Retarded | 2103 Wilson Ave, Charlotte, NC 28208-4655 | 2007-03-31 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.