Healthcare Provider Details

I. General information

NPI: 1912166497
Provider Name (Legal Business Name): LIFETIME HOME HEALTH CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13335 SW 124TH ST STE 103
MIAMI FL
33186-7513
US

IV. Provider business mailing address

13335 SW 124TH ST STE 103
MIAMI FL
33186-7513
US

V. Phone/Fax

Practice location:
  • Phone: 305-412-9070
  • Fax: 305-412-7773
Mailing address:
  • Phone: 305-412-9070
  • Fax: 305-412-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALBERT CARLOS LEY JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-412-9070