Provider Demographics
NPI:1093041576
Name:LIFESPAN...A COMMUNITY SERVICE
Entity Type:Organization
Organization Name:LIFESPAN...A COMMUNITY SERVICE
Other - Org Name:JOEY'S JUNCTION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREYSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-784-4426
Mailing Address - Street 1:524 LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2804
Mailing Address - Country:US
Mailing Address - Phone:517-817-0096
Mailing Address - Fax:517-789-7883
Practice Address - Street 1:524 LANSING AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2804
Practice Address - Country:US
Practice Address - Phone:517-817-0096
Practice Address - Fax:517-789-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care