MEDICARE: LSE HEALTHCARE

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	:	1679049951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LSE HEALTHCARE

Provider Business Mailing Address
First Line	:	8115 ORWIN MANOR LN APT 204
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-9008
Country	:	US
Telephone Number	:	904-290-0995
Fax Number	:

Provider Business Practice Location Address
First Line	:	8115 ORWIN MANOR LN APT 204
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-9008
Country	:	US
Telephone Number	:	904-290-0995
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LATONYA EARLS
Credential	:
Telephone Number	:	904-290-0995

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	03/31/2020

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