MEDICARE: LIFETIMENURSESCARE, 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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1205435732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIMENURSESCARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 550893
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75355-0893
Country	:	US
Telephone Number	:	469-226-8275
Fax Number	:	214-341-7705

Provider Business Practice Location Address
First Line	:	10875 PLANO RD STE 103
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-1369
Country	:	US
Telephone Number	:	214-341-7778
Fax Number	:	214-341-7705

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. BENJAMIN CHIDOZIE NWOSU
Credential	:
Telephone Number	:	469-226-8275

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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