MEDICARE: LIFECARE ALLIANCE

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	251V00000X	Voluntary or Charitable Agency		OH

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	:	1992978068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFECARE ALLIANCE

Provider Business Mailing Address
First Line	:	1699 W MOUND ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1809
Country	:	US
Telephone Number	:	614-278-3130
Fax Number	:	614-278-3143

Provider Business Practice Location Address
First Line	:	1699 W MOUND ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1809
Country	:	US
Telephone Number	:	614-278-3130
Fax Number	:	614-278-3143

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. CHARLES GEHRING
Credential	:
Telephone Number	:	614-278-3130

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	03/01/2012

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Directions to “LIFECARE ALLIANCE ” Practice Location

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