Healthcare Provider Details

I. General information

NPI: 1801236534
Provider Name (Legal Business Name): LYFE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 CRESTVIEW DR
HOUSTON TX
77028-2606
US

IV. Provider business mailing address

15313 KINGFIELD DR
HOUSTON TX
77084-1410
US

V. Phone/Fax

Practice location:
  • Phone: 281-940-5933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MISS AISHA WALDRUP
Title or Position: ADIMISTRATIONS
Credential: 2819405933
Phone: 281-940-5933