Organization
LIFECARE FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANDON KENT MAUCK BBA (HR COORDINATOR)
61578010013
Entity
Organization
Contact information
Practice address
663 SOUTH JEFFERSON AVE, COOKEVILLE, TN 38501
(931) 528-0051
Mailing address
663 SOUTH JEFFERSON AVE, COOKEVILLE, TN 38501
(931) 528-0051
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3376955
GROUP MEDICARE
TN
Enumeration date
10/19/2009
Last updated
10/19/2009
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