Basic Information
| Provider Information | |||||||||
| NPI: | 1780132712 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIFECARE VIRTUAL HOME HEALTH LLC | ||||||||
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| OtherOrganizationName: | LIFECARE VIRTUAL HOME HEALTH | ||||||||
| 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 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 GUS THOMASSON RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751504028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142714361 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2016 | ||||||||
| LastUpdateDate: | 09/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | CRONIN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF GOVT AFFAIRS & REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4692412128 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.