=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720435860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFECARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2016
-----------------------------------------------------
Last Update Date | 05/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 EDGEWATER DR STE 215
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-383-9212
-----------------------------------------------------
Fax | 510-383-9214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7700 EDGEWATER DR STE 215
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-383-9212
-----------------------------------------------------
Fax | 510-383-9214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONSULTANT
-----------------------------------------------------
Name | GRACE ROWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-921-6345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------