Provider Demographics
NPI:1841335650
Name:LIFESPRING, INC
Entity type:Organization
Organization Name:LIFESPRING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-206-1240
Mailing Address - Street 1:460 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-206-1240
Mailing Address - Fax:812-206-1243
Practice Address - Street 1:460 SPRING STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-206-1240
Practice Address - Fax:812-206-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN402251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN125400Medicare ID - Type UnspecifiedPHD'S
IN125390Medicare ID - Type UnspecifiedLCSW'S
IN170460Medicare ID - Type UnspecifiedPSYD'S
IN124980Medicare ID - Type UnspecifiedMD'S