MEDICARE: LIFE'S PATH FORWARD LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251E00000X	Home Health Agency
4	251J00000X	Nursing Care Agency
5	251K00000X	Public Health or Welfare Agency
6	253Z00000X	In Home Supportive Care Agency
7	347C00000X	Private Vehicle
8	177F00000X	Lodging Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NB4842LP4WD	OTHER		SERVICES PROVIDER

General Provider Information

NPI Number	:	1013627942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE'S PATH FORWARD LLC

Provider Business Mailing Address
First Line	:	PO BOX 331048
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77233-1048
Country	:	US
Telephone Number	:	832-316-8566
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 LINCOLNSHIRE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-4723
Country	:	US
Telephone Number	:	832-316-8566
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MRS. KANDZ KELLY DAIGLE
Credential	:
Telephone Number	:	832-316-8566

Provider Enumeration Date	:	12/01/2022
Last Update Date	:	12/01/2022

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Directions to “LIFE'S PATH FORWARD LLC ” Practice Location

Language	Start Address	Practice Location

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