Provider Demographics
NPI:1841291515
Name:LIFE CARE INC.
Entity type:Organization
Organization Name:LIFE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-775-6236
Mailing Address - Street 1:114 E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-4622
Mailing Address - Country:US
Mailing Address - Phone:918-775-6236
Mailing Address - Fax:918-775-1226
Practice Address - Street 1:114 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4622
Practice Address - Country:US
Practice Address - Phone:918-775-6236
Practice Address - Fax:918-775-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0359060001Medicare ID - Type Unspecified