Healthcare Provider Details

I. General information

NPI: 1265976492
Provider Name (Legal Business Name): LIFECARE FUSION HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10508 SPRING HILL DR
SPRING HILL FL
34608-5046
US

IV. Provider business mailing address

5340 LEGACY DR STE 150
PLANO TX
75024-3178
US

V. Phone/Fax

Practice location:
  • Phone: 727-328-0599
  • Fax: 727-328-2071
Mailing address:
  • Phone: 469-241-2100
  • Fax: 469-241-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MICHAEL CRONIN
Title or Position: VP REIMBURSEMENT
Credential: CPA
Phone: 469-241-2128