Healthcare Provider Details

I. General information

NPI: 1962026567
Provider Name (Legal Business Name): LYFE PRESENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N RIDGEWAY AVE
CHICAGO IL
60624-1230
US

IV. Provider business mailing address

PO BOX 496061
CHICAGO IL
60649-0001
US

V. Phone/Fax

Practice location:
  • Phone: 872-212-5933
  • Fax:
Mailing address:
  • Phone: 872-212-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANTA S WHITE
Title or Position: OWNER
Credential:
Phone: 872-212-5933