Provider Demographics
NPI:1376805606
Name:LIFE CARE INC
Entity Type:Organization
Organization Name:LIFE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENEDICT
Authorized Official - Middle Name:
Authorized Official - Last Name:FORETIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-651-8785
Mailing Address - Street 1:7320 LONGBRANCH DR
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3642
Mailing Address - Country:US
Mailing Address - Phone:301-651-8785
Mailing Address - Fax:301-345-9190
Practice Address - Street 1:7320 LONGBRANCH DR
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3642
Practice Address - Country:US
Practice Address - Phone:301-651-8785
Practice Address - Fax:301-345-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2513251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care