| Lifespan Incorporated | |
|
27 Bona Vista Dr Marble NC 28905-8646 | |
| (828) 321-9992 | |
| Not Available |
| Full Name | Lifespan Incorporated |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 27 Bona Vista Dr, Marble, North Carolina |
| Authorized Official Name and Position | Robin Devore (VP CORPORATE COMPLIANCE/PROGRAM OPS) |
| Authorized Official Contact | 7049445136 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan Incorporated 1511 Shopton Rd Suite A Charlotte NC 28217-3239 Ph: () - | Lifespan Incorporated 27 Bona Vista Dr Marble NC 28905-8646 Ph: (828) 321-9992 |
| NPI Number | 1144683210 |
|---|---|
| Provider Enumeration Date | 04/05/2016 |
| Last Update Date | 01/26/2021 |
| Certification Date | 01/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144683210 | NPI | - | NPPES |
| 020-071 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHL-020-071 (North Carolina) | Primary |