Healthcare Provider Details

I. General information

NPI: 1134871353
Provider Name (Legal Business Name): LONGLIFE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NIANTIC AVE STE B
PROVIDENCE RI
02907-3146
US

IV. Provider business mailing address

100 NIANTIC AVE STE B
PROVIDENCE RI
02907-3146
US

V. Phone/Fax

Practice location:
  • Phone: 401-251-2166
  • Fax: 401-240-4415
Mailing address:
  • Phone: 401-251-2166
  • Fax: 401-240-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RASAQ A ALABEDE
Title or Position: ADMINSTRATOR
Credential:
Phone: 401-699-1196