NPIMap

Organization Active NPI

Lifespan, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Concord, NC
National Provider Identifier
1306994058
Registry record updated Jun 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
MHL-013-004 Issued in NC
Legal business name
LIFESPAN, INC.
Practice address
56 Macachern Blvd
Concord, NC 28025-3533
Phone
(704) 784-2845
Fax
(704) 785-8116
NPI assigned
Jan 8, 2007
Last updated
Jun 3, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2013

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

Authorized official

Name
Ms. Davan Cloninger, BA,MA
Title
Ceo/President
Phone
(704) 944-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X MHL-013-004 NC Primary

Addresses

Primary practice location

56 Macachern Blvd
Concord, NC 28025-3533

Mailing address

200 Clanton Rd
Charlotte, NC 28217-1304
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 24

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

View all 24

Locations

56 McCachern Blvd SE
Concord, NC 28025
Phone (704) 784-2845

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370217600000",
    "number": "1306994058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CLANTON RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282171304",
            "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": "56 MACACHERN BLVD",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280253533",
            "telephone_number": "704-784-2845",
            "fax_number": "704-785-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2013-06-03",
        "status": "A",
        "authorized_official_last_name": "CLONINGER",
        "authorized_official_first_name": "DAVAN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "704-944-5100",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BA,MA"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "MHL-013-004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408802",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2013; 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.