Provider Demographics
NPI:1184227829
Name:THE LIFESPAN CENTER
Entity Type:Organization
Organization Name:THE LIFESPAN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANILLYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:336-694-1924
Mailing Address - Street 1:PO BOX 3058
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-3058
Mailing Address - Country:US
Mailing Address - Phone:336-694-1924
Mailing Address - Fax:
Practice Address - Street 1:293 MAIN ST
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379-8781
Practice Address - Country:US
Practice Address - Phone:336-694-1924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health