Provider Demographics
NPI:1851489942
Name:LIFESPRING, INC
Entity Type:Organization
Organization Name:LIFESPRING, INC
Other - Org Name:SOUTHERN INDIANA MENTAL HEALTH AND GUIDANCE CENTER OF ECI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-472-7396
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:812-280-2080
Mailing Address - Fax:812-206-1243
Practice Address - Street 1:460 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-280-2080
Practice Address - Fax:812-206-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN402251S00000X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100074520Medicaid
IN100425950Medicaid
IN125400Medicare ID - Type UnspecifiedPHD
IN124980Medicare ID - Type UnspecifiedMD'S
IN170460Medicare ID - Type UnspecifiedPSYD
IN125390Medicare ID - Type UnspecifiedLICENSED CLINICAL