MEDICARE: LG CHARITY HOME HEALTH CARE SERVICES, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	251E00000X	Home Health Agency
2	3747P1801X	Personal Care Attendant
3	251E00000X	Home Health Agency	TX

General Provider Information

NPI Number	:	1336213537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LG CHARITY HOME HEALTH CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	9535 FOREST LN STE 246
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-5959
Country	:	US
Telephone Number	:	469-372-0882
Fax Number	:	469-420-5373

Provider Business Practice Location Address
First Line	:	2401 CALLENDER RD STE 109
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-8869
Country	:	US
Telephone Number	:	817-617-2381
Fax Number	:	817-617-2379

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LOVELINE MAFOR NCHE
Credential	:
Telephone Number	:	817-617-2381

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	02/09/2024

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