Provider Demographics
NPI:1215910872
Name:LIFESPACE COMMUNITIES INC
Entity type:Organization
Organization Name:LIFESPACE COMMUNITIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-288-5805
Mailing Address - Street 1:401 E LINTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5028
Mailing Address - Country:US
Mailing Address - Phone:561-272-7979
Mailing Address - Fax:
Practice Address - Street 1:401 E LINTON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5028
Practice Address - Country:US
Practice Address - Phone:561-272-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPACE COMMUNITIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-28
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1195096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021639900Medicaid
FL021639900Medicaid