=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669497665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFECARE MANAGEMENT SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 11/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5340 LEGACY DR SUITE 150
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-241-2128
-----------------------------------------------------
Fax | 469-241-2177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5340 LEGACY DR SUITE 150
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-241-2128
-----------------------------------------------------
Fax | 469-241-2177
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT OF REIMBURSEMENT
-----------------------------------------------------
Name | MR. MICHAEL CRONIN
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 469-241-2128
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282E00000X
-----------------------------------------------------
Taxonomy Name | Long Term Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------