MEDICARE: LIFECARE DIALYSIS CENTER INC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235168436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFECARE DIALYSIS CENTER INC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	STE 400 L&C
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4218
Fax Number	:	303-209-7825

Provider Business Practice Location Address
First Line	:	221 W 61ST ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-7832
Country	:	US
Telephone Number	:	212-977-6100
Fax Number	:	212-974-9015

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. WALTER WASSER
Credential	:
Telephone Number	:	212-977-3100

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	06/24/2008

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