Provider Demographics
NPI:1073130894
Name:LIFECARE WELLNESS
Entity Type:Organization
Organization Name:LIFECARE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-331-3836
Mailing Address - Street 1:216 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:GORDO
Mailing Address - State:AL
Mailing Address - Zip Code:35466-2221
Mailing Address - Country:US
Mailing Address - Phone:205-331-3836
Mailing Address - Fax:205-293-5516
Practice Address - Street 1:653 HELEN KELLER BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2983
Practice Address - Country:US
Practice Address - Phone:205-331-3836
Practice Address - Fax:205-293-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1124305081OtherNPI