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General NPI Number Information
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NPI Number | 1699980771
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Entity Type | Organization
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Legal Business Name | LIFE CARE CENTER OF AMERICA
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 33801 1ST WAY S STE 301
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City | FEDERAL WAY
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State | WA
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Zip | 98003-4548
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Country | US
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Telephone | 253-952-2184
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Fax |
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Provider Business Mailing Address
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Address Line | 3829 NE 35TH AVE
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City | PORTLAND
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State | OR
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Zip | 97212-1824
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGIONAL REHAB DIRECTOR
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Name | DIEU DINH
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Credential | DPT
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Telephone | 503-473-9057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 5120
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License Number State | OR
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