| Lifespan Inc | |
|
4806 Farm Pond Ln Charlotte NC 28212-8558 | |
| (704) 536-7739 | |
| Not Available |
| Full Name | Lifespan Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4806 Farm Pond Ln, Charlotte, North Carolina |
| Authorized Official Name and Position | Robin Devore (VP CORPORATE COMPLIANCE AND PROGRAM) |
| Authorized Official Contact | 7049445100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan Inc 1511 Shopton Rd Suite A Charlotte NC 28217-3239 Ph: (704) 944-5100 | Lifespan Inc 4806 Farm Pond Ln Charlotte NC 28212-8558 Ph: (704) 536-7739 |
| NPI Number | 1477099752 |
|---|---|
| Provider Enumeration Date | 01/11/2017 |
| Last Update Date | 01/11/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477099752 | NPI | - | NPPES |
| 3408802 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHL-060-1336 (North Carolina) | Primary |
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