MEDICARE: LIFESPAN HEALTH CARE, 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	251E00000X	Home Health Agency	7315	OK

General Provider Information

NPI Number	:	1538155056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESPAN HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	500A E 4TH ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003-3905
Country	:	US
Telephone Number	:	918-337-0601
Fax Number	:	918-337-0558

Provider Business Practice Location Address
First Line	:	500 E 4TH ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003-3905
Country	:	US
Telephone Number	:	918-337-0601
Fax Number	:	918-337-0558

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JIMMIE KATE MOUSE
Credential	:	RN
Telephone Number	:	918-337-0601

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/02/2009

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