Provider Demographics
NPI:1104902790
Name:LIFECARE INC
Entity type:Organization
Organization Name:LIFECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELEANORE
Authorized Official - Middle Name:BARTOLOME
Authorized Official - Last Name:AGUILUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-982-2998
Mailing Address - Street 1:8900 BENSON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1669
Mailing Address - Country:US
Mailing Address - Phone:909-982-2998
Mailing Address - Fax:909-982-3688
Practice Address - Street 1:8900 BENSON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1669
Practice Address - Country:US
Practice Address - Phone:909-982-2998
Practice Address - Fax:909-982-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4984430001Medicare NSC