Provider Demographics
NPI:1083799530
Name:LIFESPAN CORP LFSPN DSI DBA HOSPICE OF RI
Entity Type:Organization
Organization Name:LIFESPAN CORP LFSPN DSI DBA HOSPICE OF RI
Other - Org Name:HOME & HOSPICE CARE OF RHODE ISLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HELGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-724-3287
Mailing Address - Street 1:169 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3853
Mailing Address - Country:US
Mailing Address - Phone:401-727-7070
Mailing Address - Fax:401-312-2321
Practice Address - Street 1:169 GEORGE ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3853
Practice Address - Country:US
Practice Address - Phone:401-727-7070
Practice Address - Fax:401-312-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHNC02313251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP003718OtherBLUE CHIP OF RI
58056OtherBLUE CROSS OF RI
RIHC04010Medicaid
CP003718OtherBLUE CHIP OF RI