MEDICARE: LIFE CARE AT HOME OF RHODE ISLAND, 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	251E00000X	Home Health Agency	02286	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58748	OTHER	RI	BLUECROSS BLUE SHIELD
2	409746	OTHER	RI	BLUE CHIP PROVIDER

General Provider Information

NPI Number	:	1346243490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CARE AT HOME OF RHODE ISLAND, INC.

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5256
Fax Number	:	423-339-8356

Provider Business Practice Location Address
First Line	:	63 SOCKANOSSET CROSS RD
Second Line	:	STE 1C
City	:	CRANSTON
State	:	RI
Zip	:	02920-5557
Country	:	US
Telephone Number	:	508-238-6878
Fax Number	:	508-238-6980

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	PAMELA RAU
Credential	:
Telephone Number	:	423-473-5280

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/30/2011

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