MEDICARE: LIFE CARE COMMUNITY 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1487441937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CARE COMMUNITY LLC

Provider Business Mailing Address
First Line	:	4373 W LENNOX DR
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-9786
Country	:	US
Telephone Number	:	385-420-1249
Fax Number	:

Provider Business Practice Location Address
First Line	:	4373 W LENNOX DR
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-9786
Country	:	US
Telephone Number	:	385-420-1249
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	VENANT NSABIMANA BIGWI
Credential	:
Telephone Number	:	385-420-1249

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/21/2025

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Directions to “LIFE CARE COMMUNITY LLC ” Practice Location

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