NPIMap

Organization Active NPI

Lifespan, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Statesville, NC
National Provider Identifier
1003965781
Registry record updated Nov 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
49000254 Issued in NC
Legal business name
LIFESPAN, INC.
Practice address
302 W Broad St
Statesville, NC 28677-5260
Phone
(704) 872-8579
Fax
(704) 872-5272
NPI assigned
Jan 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robin Devore, BA
Title
VP Corporate Compliance/Program Ops
Phone
(704) 944-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 49000254 NC Primary

Addresses

Primary practice location

302 W Broad St
Statesville, NC 28677-5260

Mailing address

1511 Shopton Rd
Suite a
Charlotte, NC 28217-3239
Phone (704) 944-5100

Other identifiers 1

IdentifierTypeStateIssuer
3408802MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Lifespan Inc58 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

302 W Broad St
Statesville, NC 28677
Phone (704) 872-8579

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478217600000",
    "number": "1003965781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 SHOPTON RD",
            "address_2": "SUITE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282173239",
            "telephone_number": "704-944-5100",
            "fax_number": "704-944-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W BROAD ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286775260",
            "telephone_number": "704-872-8579",
            "fax_number": "704-872-5272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2016-11-04",
        "status": "A",
        "authorized_official_last_name": "DEVORE",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "VP CORPORATE COMPLIANCE/PROGRAM OPS",
        "authorized_official_telephone_number": "704-944-5100",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "49000254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408802",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.