MEDICARE: LIFE CHANGING ASSISTANCE HEALTHCARE, 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		TX
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1801320064	OTHER	TX	SOLE PROPRIETOR

General Provider Information

NPI Number	:	1083104806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CHANGING ASSISTANCE HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	5025 DOOLITTLE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-3494
Country	:	US
Telephone Number	:	832-715-2358
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 DOOLITTLE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033
Country	:	US
Telephone Number	:	832-715-2358
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TATYANNA LUSK
Credential	:
Telephone Number	:	832-715-2358

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	11/26/2019

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