Healthcare Provider Details

I. General information

NPI: 1649714791
Provider Name (Legal Business Name): LIFECARE FUSION HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N REO ST STE 109
TAMPA FL
33609-1061
US

IV. Provider business mailing address

5340 LEGACY DR STE150
PLANO TX
75024-3178
US

V. Phone/Fax

Practice location:
  • Phone: 813-636-5017
  • Fax: 813-282-1166
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 Number299991758
License Number StateFL

VIII. Authorized Official

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