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General NPI Number Information
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NPI Number | 1326223702
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Entity Type | Organization
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Legal Business Name | LIFE TIME HOME CARE SERVICES
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 577 PINE VALLEY DR SUITE 200
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6629
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Country | US
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Telephone | 678-523-8082
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Fax | 678-567-5246
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Provider Business Mailing Address
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Address Line | 577 PINE VALLEY DR SUITE 200
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City | POWDR SPRING
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State | GA
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Zip | 30127
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Country | US
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Telephone | 678-523-8082
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Fax | 675-567-5246
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Authorized Official
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Title or Position | DIRECTOR/OWENER
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Name | MRS. BETTY KELLY LEE
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Credential | ETC
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Telephone | 678-523-8082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 110R0225
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 110-R-0225
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License Number State | GA
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