MEDICARE: LIFE SPAN HOME HEALTH, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9059	OTHER	TX	STATE PROGRAMS WAIVER

General Provider Information

NPI Number	:	1245474246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SPAN HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	11325 PEGASUS ST STE S142
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-5239
Country	:	US
Telephone Number	:	214-342-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	11325 PEGASUS ST STE S142
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-5239
Country	:	US
Telephone Number	:	214-342-3000
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. DEETRA MITCHELLE NELSON
Credential	:
Telephone Number	:	214-342-3000

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

Similar Medicare Providers

1255589834 — FARMINGTON PLACE HEALTHCARE SERVICES
Practice Location Address:

11325 PEGASUS ST # S-142
DALLAS, TX
75238-5239

Practice Phone: 214-221-0020
Practice Fax:

1417010166 — DR. ROBERT C. SCHWARTZ JR. M.D.
Practice Location Address:

5109 SWISS AVE
DALLAS, TX
75214-5239

Practice Phone: 214-823-9422
Practice Fax: 214-824-0829

1497073753 — ROBERT C SCHWARTZ MD PA
Practice Location Address:

5109 SWISS AVE
DALLAS, TX
75214-5239

Practice Phone: 214-823-9422
Practice Fax: 214-824-0829

1801199476 — DR. KRISTI GENOVESE BAKER PH.D.
Practice Location Address:

6300 HARRY HINES BLVD STE 1200
DALLAS, TX
75235-5239

Practice Phone: 214-456-5932
Practice Fax: 214-456-4273

1376235788 — MS. ZYMEASHIA GORRELL FNP-C
Practice Location Address:

4607 TIMBERGLEN RD APT 317
DALLAS, TX
75287-5239

Practice Phone: 609-876-0665
Practice Fax:

1811841075 — HEALING HEARTS MEDICAL, LLC
Practice Location Address:

10935 ESTATE LN STE S132
DALLAS, TX
75238-2316

Practice Phone: 214-584-6359
Practice Fax: 214-380-5227

Directions to “LIFE SPAN HOME HEALTH, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.