Provider Demographics
NPI:1861785735
Name:LIFE CARE HOSPICE, LLC
Entity type:Organization
Organization Name:LIFE CARE HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISRTATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:TRULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-339-0431
Mailing Address - Street 1:934 GRUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2637
Mailing Address - Country:US
Mailing Address - Phone:205-631-6636
Mailing Address - Fax:205-631-6607
Practice Address - Street 1:934 GRUBBS AVE
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2637
Practice Address - Country:US
Practice Address - Phone:205-631-6636
Practice Address - Fax:205-631-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6465251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL073-P3725OtherSHPDA ID NUMBER
ALE3727OtherSTALE LICENSE
AL01-1646Medicare UPIN