Provider Demographics
NPI:1760783633
Name:LIFECARE
Entity Type:Organization
Organization Name:LIFECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:GILBREATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-747-3798
Mailing Address - Street 1:560 COUNTY ROAD 825
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:AL
Mailing Address - Zip Code:35098-1425
Mailing Address - Country:US
Mailing Address - Phone:256-747-3798
Mailing Address - Fax:
Practice Address - Street 1:560 COUNTY ROAD 825
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:AL
Practice Address - Zip Code:35098-1425
Practice Address - Country:US
Practice Address - Phone:256-747-3798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric