MEDICARE: HOME HEALTH LIFE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	A-081-011	KS

General Provider Information

NPI Number	:	1013461045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH LIFE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1803
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66505-1803
Country	:	US
Telephone Number	:	785-492-2992
Fax Number	:	785-370-8000

Provider Business Practice Location Address
First Line	:	617 HIGHLAND RIDGE DR APT 6301
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66503-5004
Country	:	US
Telephone Number	:	785-492-2992
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MEGAN L DONOVAN
Credential	:
Telephone Number	:	785-492-2992

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	08/08/2016

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Directions to “HOME HEALTH LIFE LLC ” Practice Location

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