MEDICARE: LIFE GENERATIONS HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1053345660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE GENERATIONS HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	6 HUTTON CENTRE DR STE 400
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-8762
Country	:	US
Telephone Number	:	714-241-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 HUTTON CENTRE DR STE 400
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-8762
Country	:	US
Telephone Number	:	714-241-5600
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	LOIS A MASTROCOLA
Credential	:
Telephone Number	:	714-241-5600

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/14/2026

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