Basic Information
| Provider Information | |||||||||
| NPI: | 1598741399 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFESPAN FAMILY HEALTHCARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | NEWCASTLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045533838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075633366 | ||||||||
| FaxNumber: | 2075633393 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | NEWCASTLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045533838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075633366 | ||||||||
| FaxNumber: | 2075633393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 07/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | LOVLEY | ||||||||
| AuthorizedOfficialFirstName: | SANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2075633366 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.