MEDICARE: LIFECARE, 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	394170	MI

General Provider Information

NPI Number	:	1649261488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFECARE, INC.

Provider Business Mailing Address
First Line	:	1400 N DRAKE RD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-1978
Country	:	US
Telephone Number	:	269-381-0560
Fax Number	:	269-381-5354

Provider Business Practice Location Address
First Line	:	1400 N DRAKE RD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006
Country	:	US
Telephone Number	:	269-381-0560
Fax Number	:	269-381-5354

Authorized Official
Title or Position	:	DIRECTOR OF ACCOUNTING
Name	:	RUSSELL DAVID GOODRICH
Credential	:
Telephone Number	:	269-381-0560

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	08/28/2019

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Directions to “LIFECARE, INC. ” Practice Location

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