Healthcare Provider Details

I. General information

NPI: 1538360409
Provider Name (Legal Business Name): LONG LIFE HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BELT LINE RD STE 103 N
CEDAR HILL TX
75104-2006
US

IV. Provider business mailing address

301 W BELT LINE RD STE 103 N
CEDAR HILL TX
75104-2006
US

V. Phone/Fax

Practice location:
  • Phone: 972-291-7007
  • Fax: 972-291-7008
Mailing address:
  • Phone: 972-291-7007
  • Fax: 972-291-7008

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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number45D09820728
License Number StateTX

VIII. Authorized Official

Name: MR. GREGORY LYNN DAVIS
Title or Position: DON
Credential: RN
Phone: 972-291-7007