Provider Demographics
NPI:1992935712
Name:LIFECARE MISSOURI INC.
Entity type:Organization
Organization Name:LIFECARE MISSOURI INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-697-8844
Mailing Address - Street 1:2190 S. MASON ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-984-8650
Mailing Address - Fax:314-909-1033
Practice Address - Street 1:2190 S. MASON ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-984-8650
Practice Address - Fax:314-909-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO835-HH251E00000X, 251F00000X, 251J00000X, 253Z00000X
347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO835-HHOtherMISSOURI DEPARTMENT OF HEALTH & SENIOR SERVICES, HOME HEALTH AGENCY LICENSE
MO516564OtherTHE JOINT COMMISSION (JCAHO)