Provider Demographics
NPI:1386841138
Name:LIFECARE CENTER OF AMERICIA
Entity Type:Organization
Organization Name:LIFECARE CENTER OF AMERICIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MACCCSLP
Authorized Official - Phone:330-483-3131
Mailing Address - Street 1:2400 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9414
Mailing Address - Country:US
Mailing Address - Phone:330-483-3131
Mailing Address - Fax:330-483-3132
Practice Address - Street 1:2400 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9414
Practice Address - Country:US
Practice Address - Phone:330-483-3131
Practice Address - Fax:330-483-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA1046314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility