Healthcare Provider Details

I. General information

NPI: 1811200595
Provider Name (Legal Business Name): LIFE TIME PERSONAL CARE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 COMMON ST SUITE 2660
NEW ORLEANS LA
70112-2401
US

IV. Provider business mailing address

1010 COMMON ST SUITE 2660
NEW ORLEANS LA
70112-2401
US

V. Phone/Fax

Practice location:
  • Phone: 504-962-3101
  • Fax: 504-962-3102
Mailing address:
  • Phone: 504-962-3101
  • Fax: 504-962-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number11694
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number11694
License Number StateLA

VIII. Authorized Official

Name: MRS. SANDRA DELAINE THRASH
Title or Position: ADMINISTRATOR
Credential:
Phone: 504-962-3101