Healthcare Provider Details

I. General information

NPI: 1699836635
Provider Name (Legal Business Name): LIFE CARE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N MAIN ST
GLASSBORO NJ
08028-1637
US

IV. Provider business mailing address

601 N MAIN ST PO BOX 900
GLASSBORO NJ
08028-1637
US

V. Phone/Fax

Practice location:
  • Phone: 856-881-5800
  • Fax: 856-881-3511
Mailing address:
  • Phone: 856-881-5800
  • Fax: 856-881-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONARD A KRAUS
Title or Position: PRESIDENT
Credential:
Phone: 856-881-5800