Provider Demographics
NPI:1720136971
Name:LIFESHARE MANAGEMENT GROUP, INC.
Entity type:Organization
Organization Name:LIFESHARE MANAGEMENT GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:DOUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-868-1607
Mailing Address - Street 1:60 ROGERS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5070
Mailing Address - Country:US
Mailing Address - Phone:603-625-8825
Mailing Address - Fax:603-625-8875
Practice Address - Street 1:60 ROGERS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-625-8825
Practice Address - Fax:603-625-8875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESHARE MANAGEMENT GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-06
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253J00000XAgenciesFoster Care Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691380698Medicaid
NH92115OtherNH DCYF
GA003112847AMedicaid
GA003112847CMedicaid
RI601100761Medicaid
NH30852455Medicaid
NH30854701Medicaid
NH3086307Medicaid
RILS72653Medicaid
FL000646400Medicaid
ME410790000Medicaid
ME410790100Medicaid
FL691380696Medicaid
NH92116OtherNH DCYF
SC140BHSMedicaid