NPIMap

Organization Active NPI

Lifespan Inc

  • Community/Behavioral Health Agency
  • Brevard, NC
National Provider Identifier
1942745005
Registry record updated Dec 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL088036 Issued in NC
Legal business name
LIFESPAN INC
Practice address
31 James St
Brevard, NC 28712-3779
Phone
(704) 944-5100
NPI assigned
Dec 28, 2016
Last updated
Dec 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2016

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) 944-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL088036 NC Primary

Addresses

Primary practice location

31 James St
Brevard, NC 28712-3779

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482883200000",
    "number": "1942745005",
    "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": "31 JAMES ST",
            "city": "BREVARD",
            "state": "NC",
            "postal_code": "287123779",
            "telephone_number": "704-944-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-28",
        "last_updated": "2016-12-28",
        "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": "704-944-5100"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL088036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408802",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brevard, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.