Provider Demographics
NPI:1306140264
Name:LIFESPAN FAMILY CARE, LLC
Entity type:Organization
Organization Name:LIFESPAN FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-309-3934
Mailing Address - Street 1:4106 LOST OAK DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8438
Mailing Address - Country:US
Mailing Address - Phone:423-309-3934
Mailing Address - Fax:423-499-8616
Practice Address - Street 1:4106 LOST OAK DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8438
Practice Address - Country:US
Practice Address - Phone:423-309-3934
Practice Address - Fax:423-499-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13170314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility