Provider Demographics
NPI:1174079867
Name:LIFECAREPROS, LLC
Entity type:Organization
Organization Name:LIFECAREPROS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-343-5093
Mailing Address - Street 1:1345 110TH ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-4527
Mailing Address - Country:US
Mailing Address - Phone:224-343-5093
Mailing Address - Fax:
Practice Address - Street 1:223 NORTH ROUTE 21
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-388-0014
Practice Address - Fax:847-268-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001214253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care