Organization
LIFELINE
Active
Parent organization
LIFECARE FAMILY SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFECARE FAMILY SERVICES
Authorized official
LANDON KENT MAUCK BBA (HR COORDINATOR)
(615) 781-0013
Entity
Organization
Contact information
Practice address
599 VICKERS PL STE D, COOKEVILLE, TN 38501-4076
(931) 525-6773
Mailing address
599 VICKERS PL STE D, COOKEVILLE, TN 38501-4076
(931) 525-6773
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
I000000003680
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3376955
GROUP MEDICARE
TN
Enumeration date
12/09/2008
Last updated
12/09/2008
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