MEDICARE: LIFETIME HOME 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	251E00000X	Home Health Agency	NOT REQUIRED BY MI	MI

General Provider Information

NPI Number	:	1518987452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME HOME CARE, INC.

Provider Business Mailing Address
First Line	:	3058 METROPOLITAN PKWY
Second Line	:	SUITE 111
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3671
Country	:	US
Telephone Number	:	586-825-0304
Fax Number	:	586-825-0306

Provider Business Practice Location Address
First Line	:	3058 METROPOLITAN PKWY
Second Line	:	SUITE 111
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3671
Country	:	US
Telephone Number	:	586-825-0304
Fax Number	:	586-825-0306

Authorized Official
Title or Position	:	VP/ ADMINISTRATOR
Name	:	MRS. CARMENCITA C. GAMBALAN
Credential	:	RN
Telephone Number	:	586-825-0304

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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