Healthcare Provider Details

I. General information

NPI: 1568775245
Provider Name (Legal Business Name): LIFECARE RESOURCE GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 GREEN ST NE
GAINESVILLE GA
30501-3316
US

IV. Provider business mailing address

634 GREEN ST NE
GAINESVILLE GA
30501-3316
US

V. Phone/Fax

Practice location:
  • Phone: 678-928-9150
  • Fax: 678-450-1999
Mailing address:
  • Phone: 678-928-9150
  • Fax: 678-450-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDALL SCOTT MORRISON
Title or Position: PRESIDENT
Credential:
Phone: 678-928-9150