Provider Demographics
NPI:1720164288
Name:LIFECARE MEDICAL, INC
Entity Type:Organization
Organization Name:LIFECARE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEPAULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-542-4343
Mailing Address - Street 1:42014 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1408
Mailing Address - Country:US
Mailing Address - Phone:985-542-4343
Mailing Address - Fax:985-543-0254
Practice Address - Street 1:42014 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1408
Practice Address - Country:US
Practice Address - Phone:985-542-4343
Practice Address - Fax:985-543-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1339041Medicaid
LA1339041Medicaid