Provider Demographics
NPI:1760980965
Name:LIFECARE, INC.
Entity Type:Organization
Organization Name:LIFECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-516-1234
Mailing Address - Street 1:631 E MAIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3320
Mailing Address - Country:US
Mailing Address - Phone:970-516-1234
Mailing Address - Fax:970-516-1468
Practice Address - Street 1:631 E MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3320
Practice Address - Country:US
Practice Address - Phone:970-516-1234
Practice Address - Fax:970-516-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04E900251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO598624-00-0-001OtherUITR
CO04138707Medicaid