1083771679 NPI number — LIFE CARE CENTERS OF AMERICA, INC.

Table of content: (NPI 1083771679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083771679 NPI number — LIFE CARE CENTERS OF AMERICA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE CARE CENTERS OF AMERICA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WESTVIEW HEALTH CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083771679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 KEITH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37312-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-473-5751
Provider Business Mailing Address Fax Number:
423-339-8342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1990 W LOUCKS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERIDAN
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82801-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-672-9789
Provider Business Practice Location Address Fax Number:
307-673-1079
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CROSS
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ASSISSTANT SECRETARY
Authorized Official Telephone Number:
423-473-5867

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  05-090 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 119487900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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