MEDICARE: A LIFT FOR LIFE OUTREACH CENTER, INC.

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	251V00000X	Voluntary or Charitable Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1033598685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A LIFT FOR LIFE OUTREACH CENTER, INC.

Provider Business Mailing Address
First Line	:	5621 PARKDALE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-3207
Country	:	US
Telephone Number	:	214-367-0600
Fax Number	:	214-367-0602

Provider Business Practice Location Address
First Line	:	5621 PARKDALE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-3207
Country	:	US
Telephone Number	:	214-367-0600
Fax Number	:	214-367-0602

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CLARENCE GIDDENS
Credential	:
Telephone Number	:	214-367-0600

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	05/28/2015

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