Basic Information
| Provider Information | |||||||||
| NPI: | 1629361886 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFECARE HOSPITALS OF SARASOTA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMPLEX CARE HOSPITAL AT RIDGELAKE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5340 LEGACY DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750243178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692412100 | ||||||||
| FaxNumber: | 4692412177 | ||||||||
| Practice Location | |||||||||
| Address1: | 6150 EDGELAKE DR | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342408803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887354933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2011 | ||||||||
| LastUpdateDate: | 05/24/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CRONIN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, 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 | 282E00000X | FL | Y | Hospitals | Long Term Care Hospital |
No ID Information.