Provider Demographics
NPI:1508368440
Name:LIFESPAN FAMILY SERVICES OF PA
Entity Type:Organization
Organization Name:LIFESPAN FAMILY SERVICES OF PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-938-4408
Mailing Address - Street 1:203 LANE AVE
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2118
Mailing Address - Country:US
Mailing Address - Phone:814-938-4408
Mailing Address - Fax:814-690-1850
Practice Address - Street 1:203 LANE AVE
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2118
Practice Address - Country:US
Practice Address - Phone:814-938-4408
Practice Address - Fax:814-690-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA441380253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency