Healthcare Provider Details

I. General information

NPI: 1497561039
Provider Name (Legal Business Name): LYFETYME HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

218 CEDAR ST
SUFFOLK VA
23434-4649
US

IV. Provider business mailing address

218 CEDAR ST
SUFFOLK VA
23434-4649
US

V. Phone/Fax

Practice location:
  • Phone: 757-998-3024
  • Fax:
Mailing address:
  • Phone: 757-998-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LESTER EARL HOLLIMAN JR.
Title or Position: OWNER
Credential:
Phone: 757-998-3024