MEDICARE: LIFESPACE COMMUNITIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0017061	IL

General Provider Information

NPI Number	:	1023016730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESPACE COMMUNITIES INC

Provider Business Mailing Address
First Line	:	4201 CORPORATE DR
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-5906
Country	:	US
Telephone Number	:	515-288-5805
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 VILLAGE DR
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516
Country	:	US
Telephone Number	:	630-769-6200
Fax Number	:	630-769-6020

Authorized Official
Title or Position	:	SVP & GENERAL COUNSEL
Name	:	JODI HIRSCH
Credential	:
Telephone Number	:	515-288-5805

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/16/2018

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