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General NPI Number Information
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NPI Number | 1962283085
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Entity Type | Organization
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Legal Business Name | LIFEFORTE HOMECARE LLC
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 99 FEDERAL ST STE 1
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City | PORTLAND
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State | ME
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Zip | 04101-8206
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Country | US
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Telephone | 207-770-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 205 E US HIGHWAY 80 STE 145
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City | FORNEY
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State | TX
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Zip | 75126-8605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | OLUFEYISETAN A LALA
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Credential |
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Telephone | 207-770-0110
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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 |
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License Number State |
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