NPIMap

Organization Active NPI

Lifespan, Inc.

  • Community/Behavioral Health Agency
  • Charlotte, NC
National Provider Identifier
1144366790
Registry record updated Sep 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-011-217 Issued in NC
Legal business name
LIFESPAN, INC.
Practice address
3127 Kalynne St
Charlotte, NC 28208-3125
Phone
(704) 393-5916
Fax
(704) 393-5917
NPI assigned
Jan 30, 2007
Last updated
Sep 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2016

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X MHL-011-217 NC
Community/Behavioral Health Agency 251S00000X MHL-011-217 NC Primary

Addresses

Primary practice location

3127 Kalynne St
Charlotte, NC 28208-3125

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
8702247MedicaidNC
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 17

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

View all 17

Locations

3127 Kalynne St
Charlotte, NC 28208
Phone (704) 393-5916

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475193600000",
    "number": "1144366790",
    "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": "3127 KALYNNE ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282083125",
            "telephone_number": "704-393-5916",
            "fax_number": "704-393-5917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2016-09-30",
        "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_name_prefix": "Ms.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "MHL-011-217",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-011-217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8702247",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408802",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.