NPIMap

Organization Active NPI

Lifespan Inc

  • Community/Behavioral Health Agency
  • Charlotte, NC
National Provider Identifier
1245776533
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-060-1331 Issued in NC
Legal business name
LIFESPAN INC
Practice address
6123 Woodthrush Dr
Charlotte, NC 28227-1027
Phone
(704) 531-6857
NPI assigned
Jan 11, 2017
Last updated
Jan 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Authorized official

Name
Robin Devore
Title
VP Corporate Compliance and Program
Phone
(704) 763-1887

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL-060-1331 NC Primary

Addresses

Primary practice location

6123 Woodthrush Dr
Charlotte, NC 28227-1027

Mailing address

1511 Shopton Rd
Suite a
Charlotte, NC 28217-3239

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484092800000",
    "number": "1245776533",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6123 WOODTHRUSH DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282271027",
            "telephone_number": "704-531-6857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-11",
        "last_updated": "2017-01-11",
        "status": "A",
        "authorized_official_last_name": "DEVORE",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "VP CORPORATE COMPLIANCE AND PROGRAM",
        "authorized_official_telephone_number": "704-763-1887"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-060-1331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "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 Jan 11, 2017; 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.