MEDICARE: L.I.F.E. HOME CARE, 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	:	1568433761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L.I.F.E. HOME CARE, INC

Provider Business Mailing Address
First Line	:	PO BOX 1558
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-1558
Country	:	US
Telephone Number	:	417-683-4676
Fax Number	:	471-683-6093

Provider Business Practice Location Address
First Line	:	113 SW 2ND AVE
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-1558
Country	:	US
Telephone Number	:	417-683-4676
Fax Number	:	417-683-6093

Authorized Official
Title or Position	:	C.E.O./OWNER
Name	:	MS. DAWN MICHELLE DAVIDSON
Credential	:
Telephone Number	:	417-683-4676

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	08/22/2020

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