NPIMap

Organization Active NPI

Lifespire, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Bayside, NY
National Provider Identifier
1376755173
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
7129440 Issued in NU
Legal business name
LIFESPIRE, INC.
Practice address
61-56 219TH Street
Bayside, NY 11364
Phone
(718) 224-2413
NPI assigned
May 4, 2007
Last updated
Aug 31, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2026

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

Authorized official

Name
Emilio Bonilla
Title
Cfo
Phone
(212) 741-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 7129440 NU Primary

Addresses

Primary practice location

61-56 219TH Street
Bayside, NY 11364

Mailing address

462 7TH Ave FL 5
New York, NY 10018-7606
Phone (212) 741-0100

Other identifiers 1

IdentifierTypeStateIssuer
00357204MedicaidNY

Other names 1

  • Association for CRMD, Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376755173. Details of each certification follow.

  • CCN 33G109 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 33G109

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LIFESPIRE, INC
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Feb 28, 1980
Last certification
Jan 23, 2025
Beds
10
Ownership / control type
Private (non-profit)
Facility address
61-56 219TH St
Oakland Gardens, NY 11364

National Provider Directory

National Provider Directory
Tax ID family
Association for CRMD Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788134400000",
    "number": "1376755173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "462 7TH AVE FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100187606",
            "telephone_number": "212-741-0100",
            "fax_number": "212-320-0342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61-56 219TH STREET",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "11364",
            "telephone_number": "718-224-2413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPIRE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A",
        "authorized_official_last_name": "BONILLA",
        "authorized_official_first_name": "EMILIO",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "212-741-0100"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": "7129440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00357204",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Association for CRMD, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bayside, NY

Sources for this page

Verify at the official NPI Registry.