Provider Demographics
NPI:1518910017
Name:LIFE CARE RETIREMENT COMMUNITIES, INC.
Entity Type:Organization
Organization Name:LIFE CARE RETIREMENT COMMUNITIES, INC.
Other - Org Name:ABBEY DELRAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:POMPEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-454-2005
Mailing Address - Street 1:2000 LOWSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6008
Mailing Address - Country:US
Mailing Address - Phone:561-454-2007
Mailing Address - Fax:561-454-2033
Practice Address - Street 1:2000 LOWSON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6008
Practice Address - Country:US
Practice Address - Phone:561-454-2007
Practice Address - Fax:561-454-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10023310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK57OtherBLUE CROSS/BLUE SHIELD
FL105335Medicare ID - Type Unspecified