Provider Demographics
NPI:1598198335
Name:LIFECARE FAMILY SERVICES
Entity Type:Organization
Organization Name:LIFECARE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-781-0013
Mailing Address - Street 1:2971 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4005
Mailing Address - Country:US
Mailing Address - Phone:615-781-0013
Mailing Address - Fax:
Practice Address - Street 1:2971 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4005
Practice Address - Country:US
Practice Address - Phone:615-781-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376955Medicaid