1982929600 NPI number — LIFECARE SOLUTIONS INC

Table of content: (NPI 1982929600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982929600 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:
1982929600
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:
866-260-2230
Provider Business Mailing Address Fax Number:
858-444-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 LAS POSITAS CT STE 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVERMORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-961-9750
Provider Business Practice Location Address Fax Number:
925-961-9754
Provider Enumeration Date:
04/06/2010

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:  54980 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1982929600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54980 . This is a "HMDR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".