MEDICARE: LIFETIME HOMECARE 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1982808051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME HOMECARE SERVICES LLC

Provider Business Mailing Address
First Line	:	3230 BROOKFIELD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-6610
Country	:	US
Telephone Number	:	832-814-7008
Fax Number	:	281-454-5418

Provider Business Practice Location Address
First Line	:	3230 BROOKFIELD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-6610
Country	:	US
Telephone Number	:	832-814-7008
Fax Number	:	281-454-5418

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RUTH K KATTO
Credential	:	RN
Telephone Number	:	832-814-7008

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	09/05/2023

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