Provider Demographics
NPI:1982083564
Name:LIFESPRING, INC
Entity type:Organization
Organization Name:LIFESPRING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STAWAR
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:812-206-1234
Mailing Address - Street 1:1036 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4522
Mailing Address - Country:US
Mailing Address - Phone:812-280-2080
Mailing Address - Fax:
Practice Address - Street 1:1036 SHARON DR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4522
Practice Address - Country:US
Practice Address - Phone:812-280-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPRING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151959OtherPTAN