MEDICARE: LIFE FORWARD HOME HEALTH SERVICES 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

General Provider Information

NPI Number	:	1417627001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE FORWARD HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	2055 CRAIGSHIRE RD STE 410D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 CRAIGSHIRE RD STE 410D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4036
Country	:	US
Telephone Number	:	314-485-1515
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	VICTORIA MONTGOMERY
Credential	:
Telephone Number	:	314-485-1515

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	09/15/2021

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