Provider Demographics
NPI:1881647899
Name:LIFESPACE COMMUNITIES INC
Entity type:Organization
Organization Name:LIFESPACE COMMUNITIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-288-5805
Mailing Address - Street 1:1290 BOYCE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER ST CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:15241-3921
Mailing Address - Country:US
Mailing Address - Phone:724-941-3100
Mailing Address - Fax:724-941-6331
Practice Address - Street 1:1290 BOYCE RD
Practice Address - Street 2:
Practice Address - City:UPPER ST CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-3921
Practice Address - Country:US
Practice Address - Phone:724-941-3100
Practice Address - Fax:724-941-6331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPACE COMMUNITIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0438250004332B00000X
PA320102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011456010001Medicaid
PA0664OtherSECURITY BLUE
PA2037510OtherUS HEALTHCARE
PA0438250004Medicare NSC
PA2037510OtherUS HEALTHCARE