1023029774 NPI number — LIFECARE SOLUTIONS, INC.

Table of content: (NPI 1023029774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023029774 NPI number — LIFECARE SOLUTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFECARE SOLUTIONS, 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:
Provider Other Organization Name Type Code:
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:
1023029774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85274-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-565-1800
Provider Business Mailing Address Fax Number:
858-565-9223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15261 BARRANCA PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-258-7801
Provider Business Practice Location Address Fax Number:
714-258-7805
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEYS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
480-446-9010

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  50090 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 55607 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 50090 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DME03266F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023029774 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55607 . This is a "HMDR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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