Healthcare Provider Details

I. General information

NPI: 1336470327
Provider Name (Legal Business Name): LIFECARE HERITAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 THOMPSON LN
NASHVILLE TN
37211-2411
US

IV. Provider business mailing address

145 THOMPSON LN
NASHVILLE TN
37211-2411
US

V. Phone/Fax

Practice location:
  • Phone: 615-781-0013
  • Fax: 615-627-1441
Mailing address:
  • Phone: 615-781-0013
  • Fax: 615-627-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number5794
License Number StateTN

VIII. Authorized Official

Name: MR. LANDON KENT MAUCK
Title or Position: HUMAN RESOURCE COORDINATOR
Credential: BBA
Phone: 615-781-0013