MEDICARE: LIFE CARE HEALTH SERVICES AT HOME, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1568112209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CARE HEALTH SERVICES AT HOME, INC.

Provider Business Mailing Address
First Line	:	15549 DEVONSHIRE ST STE 102B
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-2648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15549 DEVONSHIRE ST STE 102B
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-2648
Country	:	US
Telephone Number	:	818-205-4705
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	OLENA REVEGA
Credential	:
Telephone Number	:	818-205-4705

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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