Provider Demographics
NPI:1669462826
Name:LIFE CARE AT HOME OF MASSACHUSETTS, INC.
Entity Type:Organization
Organization Name:LIFE CARE AT HOME OF MASSACHUSETTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-473-5280
Mailing Address - Street 1:3001 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3713
Mailing Address - Country:US
Mailing Address - Phone:423-473-5256
Mailing Address - Fax:423-339-8356
Practice Address - Street 1:73 STEVENS ST
Practice Address - Street 2:
Practice Address - City:EAST TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02718-1319
Practice Address - Country:US
Practice Address - Phone:508-822-6066
Practice Address - Fax:508-822-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0607401Medicaid
MA120400OtherBLUE CROSS
MA702253OtherHARVARD PILGRIM
MA0607401Medicaid