Provider Demographics
NPI:1629394606
Name:LIFESPAN CARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:LIFESPAN CARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:856-479-9045
Mailing Address - Street 1:200 FEDERAL ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1061
Mailing Address - Country:US
Mailing Address - Phone:856-479-9045
Mailing Address - Fax:856-795-1297
Practice Address - Street 1:200 FEDERAL ST
Practice Address - Street 2:SUITE 225
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1061
Practice Address - Country:US
Practice Address - Phone:856-479-9045
Practice Address - Fax:856-795-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR06230700251B00000X
PARN201503L251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management