Healthcare Provider Details

I. General information

NPI: 1215130497
Provider Name (Legal Business Name): LIFETIME LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 NO LOOP 1604 E
SAN ANTONIO TX
78247
US

IV. Provider business mailing address

5425 NO LOOP 1604 E
SAN ANTONIO TX
78247
US

V. Phone/Fax

Practice location:
  • Phone: 210-651-0279
  • Fax: 210-651-4579
Mailing address:
  • Phone: 210-651-0279
  • Fax: 210-651-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY RAY ALEXANDER
Title or Position: CEO
Credential:
Phone: 210-651-0279