| Lifespan Incorporated | |
|
264 Lillie Ln Canton NC 28716-7900 | |
| (704) 944-5100 | |
| Not Available |
| Full Name | Lifespan Incorporated |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 264 Lillie Ln, Canton, North Carolina |
| Authorized Official Name and Position | Robin Devore (VP CORPORATE COMPLIANCE AND OPERATI) |
| Authorized Official Contact | 7049445100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan Incorporated 1511 Shopton Rd Ste A Charlotte NC 28217-3240 Ph: () - | Lifespan Incorporated 264 Lillie Ln Canton NC 28716-7900 Ph: (704) 944-5100 |
| NPI Number | 1811484884 |
|---|---|
| Provider Enumeration Date | 04/16/2018 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811484884 | NPI | - | NPPES |
| 3408802 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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