Healthcare Provider Details

I. General information

NPI: 1154332880
Provider Name (Legal Business Name): LIFECARE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date: 04/04/2011
Reactivation Date: 04/26/2011

III. Provider practice location address

2240 W BROADWAY RD STE 101
MESA AZ
85202
US

IV. Provider business mailing address

PO BOX 40700
MESA AZ
85274-0700
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-2140
  • Fax: 480-733-7023
Mailing address:
  • Phone: 858-565-1800
  • Fax: 858-565-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberY003865
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberY03865
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number444
License Number StateAZ

VIII. Authorized Official

Name: WILLIAM KEYS
Title or Position: CEO
Credential:
Phone: 480-446-9010