Provider Demographics
NPI:1619143021
Name:LIFESPAN SERVICES, INC
Entity Type:Organization
Organization Name:LIFESPAN SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-847-0069
Mailing Address - Street 1:7702 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-3024
Mailing Address - Country:US
Mailing Address - Phone:727-847-0069
Mailing Address - Fax:727-849-3780
Practice Address - Street 1:7702 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-3024
Practice Address - Country:US
Practice Address - Phone:727-847-0069
Practice Address - Fax:727-849-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0560Medicare UPIN