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General NPI Number Information
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NPI Number | 1851755987
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Entity Type | Organization
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Legal Business Name | LIFE HOME, LLC
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 515A WASHINGTON AVE
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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 | 337-871-8112
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Fax | 337-871-9013
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Provider Business Mailing Address
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Address Line | 515A WASHINGTON AVE
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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 | 337-871-8112
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Fax | 337-871-9013
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. DAISY HOLMES
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Credential | 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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