Healthcare Provider Details

I. General information

NPI: 1407864960
Provider Name (Legal Business Name): LIFECARE HOME NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W LOOP 281 SUITE 204
LONGVIEW TX
75604
US

IV. Provider business mailing address

911 W LOOP 281 SUITE 204
LONGVIEW TX
75604
US

V. Phone/Fax

Practice location:
  • Phone: 903-297-9300
  • Fax: 903-297-7020
Mailing address:
  • Phone: 903-297-9300
  • Fax: 903-297-7020

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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number003475
License Number StateTX

VIII. Authorized Official

Name: AMY LYNETTE WILCOX
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-297-9300