NPIMap

Organization Active NPI

Lifespire, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Connelly, NY
National Provider Identifier
1821352972
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
LIFESPIRE, INC.
Practice address
315 James Street
Connelly, NY 12417
Phone
(845) 331-7141
NPI assigned
Jul 3, 2012
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 and/or Developmental Disabilities Residential Treatment Facility 320600000X NU Primary

Addresses

Primary practice location

315 James Street
Connelly, NY 12417

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
03499401MedicaidNY

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 1821352972. Details of each certification follow.

  • CCN 33H479 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 33H479

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
Jun 29, 2012
Last certification
Nov 20, 2025
Beds
8
Ownership / control type
Private (non-profit)
Facility address
315 James Street
Connelly, NY 12417

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": "1341273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788134400000",
    "number": "1821352972",
    "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": "315 JAMES STREET",
            "city": "CONNELLY",
            "state": "NY",
            "postal_code": "12417",
            "telephone_number": "845-331-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPIRE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-03",
        "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": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03499401",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Connelly, NY

Sources for this page

Verify at the official NPI Registry.