Provider Demographics
NPI:1699529032
Name:LIFESPRING CARE LLC
Entity type:Organization
Organization Name:LIFESPRING CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MEDARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KADIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-245-1178
Mailing Address - Street 1:443 WESTERN AVE # 1115
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1726
Mailing Address - Country:US
Mailing Address - Phone:207-245-1178
Mailing Address - Fax:
Practice Address - Street 1:15 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2521
Practice Address - Country:US
Practice Address - Phone:207-245-1178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities