Provider Demographics
NPI:1598741399
Name:LIFESPAN FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:LIFESPAN FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-563-3366
Mailing Address - Street 1:80 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:ME
Mailing Address - Zip Code:04553-3838
Mailing Address - Country:US
Mailing Address - Phone:207-563-3366
Mailing Address - Fax:207-563-3393
Practice Address - Street 1:80 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:ME
Practice Address - Zip Code:04553-3838
Practice Address - Country:US
Practice Address - Phone:207-563-3366
Practice Address - Fax:207-563-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1248Medicare ID - Type Unspecified