MEDICARE: LIFEPATH HOSPICE AND PALLIATIVE CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1134255979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEPATH HOSPICE AND PALLIATIVE CARE, INC

Provider Business Mailing Address
First Line	:	115 S MISSOURI AVE
Second Line	:	SUITE 500
City	:	LAKELAND
State	:	FL
Zip	:	33815-4600
Country	:	US
Telephone Number	:	863-682-0027
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 S MISSOURI AVE
Second Line	:	SUITE 500
City	:	LAKELAND
State	:	FL
Zip	:	33815-4600
Country	:	US
Telephone Number	:	863-682-0027
Fax Number	:

Authorized Official
Title or Position	:	EVP FINANCE AND OPERATIONS
Name	:	GEORGE H WALLACE
Credential	:
Telephone Number	:	81387187777

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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