top of page

Information Change Request

If you are a current LifeCare partner, member, or provider, please use the below form to update your information. Once you have submitted your form, it will be sent to a LifeCare Team Member for review. You will be contacted if we have any questions. 

Some of the information you can update with this form includes:

Legal Business Name

Taxpayer ID

Address/Phone Number

ACO Champion Contact Info

bottom of page