Healthcare Provider Details

I. General information

NPI: 1023280955
Provider Name (Legal Business Name): LIFECARE ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 W MOUND ST ADMINISTRATION
COLUMBUS OH
43223-1809
US

IV. Provider business mailing address

1699 W MOUND ST ADMINISTRATION
COLUMBUS OH
43223-1809
US

V. Phone/Fax

Practice location:
  • Phone: 614-278-3130
  • Fax: 614-278-3143
Mailing address:
  • Phone: 614-278-3130
  • Fax: 614-278-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. CHARLES W GEHRING
Title or Position: PRESIDENT/CEO
Credential:
Phone: 614-437-2801