NPIMap

Organization Active NPI

Lifespan Incorporated

  • Community/Behavioral Health Agency
  • North Wilkesboro, NC
National Provider Identifier
1639696941
Registry record updated Aug 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
097-078 Issued in NC
Legal business name
LIFESPAN INCORPORATED
Practice address
2070 River Road
North Wilkesboro, NC 28659
Phone
(704) 944-5100
NPI assigned
Aug 28, 2017
Last updated
Aug 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 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
Phone
(704) 944-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 097-078 NC Primary

Addresses

Primary practice location

2070 River Road
North Wilkesboro, NC 28659

Mailing address

1511 Shopton Rd Ste a
Charlotte, NC 28217-3240

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": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503878400000",
    "number": "1639696941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 SHOPTON RD STE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282173240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2070 RIVER ROAD",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "28659",
            "telephone_number": "704-944-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2017-08-28",
        "status": "A",
        "authorized_official_last_name": "DEVORE",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "VP CORPORATE COMPLIANCE",
        "authorized_official_telephone_number": "704-944-5100"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "097-078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408802",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Wilkesboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.