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General NPI Number Information
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NPI Number | 1659591444
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Entity Type | Organization
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Legal Business Name | LIFE AT HOME LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 515 WASHINGTON AVE # A
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City | MANSFIELD
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State | LA
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Zip | 71052-3105
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Country | US
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Telephone | 318-871-8112
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Fax | 318-871-9013
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Provider Business Mailing Address
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Address Line | 515 WASHINGTON AVE # A
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City | MANSFIELD
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State | LA
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Zip | 71052-3105
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Country | US
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Telephone | 318-871-8112
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Fax | 318-871-9013
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DAISY W HOLMES
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Credential | MSN,RN
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Telephone | 337-463-3595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 10567
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License Number State | LA
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