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General NPI Number Information
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NPI Number | 1144712845
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Entity Type | Organization
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Legal Business Name | LIFE AT HOME CARE SERVICES
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 803 W 57TH ST
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City | ODESSA
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State | TX
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Zip | 79764-3568
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Country | US
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Telephone | 432-272-6155
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Fax | 432-272-6165
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Provider Business Mailing Address
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Address Line | 803 W 57TH ST
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City | ODESSA
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State | TX
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Zip | 79764-3568
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Country | US
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Telephone | 432-272-6155
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Fax | 432-272-6165
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | YESENIA GONZALEZ
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Credential |
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Telephone | 432-272-6155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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