Basic Information
| Provider Information | |||||||||
| NPI: | 1144764382 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIFECARE FUSION HOME HEALTH LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FUSION HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5340 LEGACY DR | ||||||||
| Address2: | STE 150 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750243178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692412100 | ||||||||
| FaxNumber: | 4692412177 | ||||||||
| Practice Location | |||||||||
| Address1: | 10901 CORPORATE CIR N | ||||||||
| Address2: | STE A | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337163722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273288308 | ||||||||
| FaxNumber: | 7273288338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2016 | ||||||||
| LastUpdateDate: | 12/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | CRONIN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | VP REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4692412128 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 299991368 | FL | Y | Agencies | Home Health |
No ID Information.