Provider Demographics
NPI:1336475888
Name:LIFECARE FAMILY SERVICES
Entity Type:Organization
Organization Name:LIFECARE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR COORDINATOR
Authorized Official - Prefix:
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:6157-801-0013
Mailing Address - Street 1:663 SOUTH JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-528-0051
Mailing Address - Fax:
Practice Address - Street 1:663 SOUTH JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-528-0051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376955OtherGROUP MEDICARE