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General NPI Number Information
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NPI Number | 1114135332
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Entity Type | Organization
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Legal Business Name | LIFE CARE CENTERS OF AMERICA
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 304 WILMA AVE TRLR 177
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City | LOUISVILLE
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State | KY
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Zip | 40229-6632
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Country | US
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Telephone | 502-523-4387
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Fax |
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Provider Business Mailing Address
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Address Line | 304 WILMA AVE TRLR 177
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City | LOUISVILLE
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State | KY
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Zip | 40229-6632
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Country | US
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Telephone | 502-523-4387
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. LESLIE ANN MANN
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Credential | OTR
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Telephone | 812-945-2341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 31004255A
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License Number State | IN
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