Provider Demographics
NPI:1114009420
Name:LIFECARE OF CENTRAL FLORIDA, LLC
Entity Type:Organization
Organization Name:LIFECARE OF CENTRAL FLORIDA, LLC
Other - Org Name:LIFECARE OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-682-3600
Mailing Address - Street 1:398 FREEMAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4171
Mailing Address - Country:US
Mailing Address - Phone:407-682-3600
Mailing Address - Fax:407-682-7400
Practice Address - Street 1:398 FREEMAN ST
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4171
Practice Address - Country:US
Practice Address - Phone:407-682-3600
Practice Address - Fax:407-682-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683212Medicare Oscar/Certification