Provider Demographics
NPI:1245995513
Name:LIFESPAN HEALTHCARE, LLC
Entity type:Organization
Organization Name:LIFESPAN HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIBAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-593-1485
Mailing Address - Street 1:8101 SANDY SPRING RD STE E-18
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3596
Mailing Address - Country:US
Mailing Address - Phone:124-059-3148
Mailing Address - Fax:
Practice Address - Street 1:8101 SANDY SPRING RD STE E-18
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3596
Practice Address - Country:US
Practice Address - Phone:240-593-1485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health