Provider Demographics
NPI:1932132891
Name:LIFECARE OF FLORIDA LLC
Entity Type:Organization
Organization Name:LIFECARE OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:H
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-718-6062
Mailing Address - Street 1:7777 N UNIVERSITY DR STE 101S
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6106
Mailing Address - Country:US
Mailing Address - Phone:954-718-6062
Mailing Address - Fax:954-718-6099
Practice Address - Street 1:7777 N UNIVERSITY DR
Practice Address - Street 2:SUITE 101S
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6106
Practice Address - Country:US
Practice Address - Phone:954-718-6062
Practice Address - Fax:954-718-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104545Medicare ID - Type UnspecifiedPROVIDER NUMBER