Provider Demographics
NPI:1336470327
Name:LIFECARE HERITAGE
Entity Type:Organization
Organization Name:LIFECARE HERITAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:615-781-0013
Mailing Address - Street 1:145 THOMPSON LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2411
Mailing Address - Country:US
Mailing Address - Phone:615-781-0013
Mailing Address - Fax:615-627-1441
Practice Address - Street 1:145 THOMPSON LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2411
Practice Address - Country:US
Practice Address - Phone:615-781-0013
Practice Address - Fax:615-627-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5794261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care