Provider Demographics
NPI:1619698669
Name:LIFESPRING, INC
Entity Type:Organization
Organization Name:LIFESPRING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTIVE MANAGEMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWOBODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-206-1249
Mailing Address - Street 1:460 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3452
Mailing Address - Country:US
Mailing Address - Phone:812-206-1249
Mailing Address - Fax:
Practice Address - Street 1:618 E MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2914
Practice Address - Country:US
Practice Address - Phone:812-280-6606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPRING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)