Provider Demographics
NPI:1619465226
Name:LIFESPAN HEALTHCARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LIFESPAN HEALTHCARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUNKWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-801-6424
Mailing Address - Street 1:80 CREEKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4811
Mailing Address - Country:US
Mailing Address - Phone:973-801-6424
Mailing Address - Fax:
Practice Address - Street 1:80 CREEKWOOD DR
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-4811
Practice Address - Country:US
Practice Address - Phone:973-801-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty