Provider Demographics
NPI:1922034701
Name:LIFECARE HOSPICE
Entity Type:Organization
Organization Name:LIFECARE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-264-4899
Mailing Address - Street 1:1900 AKRON RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2518
Mailing Address - Country:US
Mailing Address - Phone:330-264-4899
Mailing Address - Fax:330-264-4874
Practice Address - Street 1:1900 AKRON RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2518
Practice Address - Country:US
Practice Address - Phone:330-264-4899
Practice Address - Fax:330-264-4874
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECARE HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-24
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.003501207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2831261Medicaid
OH9343931Medicare PIN