Provider Demographics
NPI:1003851700
Name:D-LIFE HEALTHCARE SERVICES,INC
Entity Type:Organization
Organization Name:D-LIFE HEALTHCARE SERVICES,INC
Other - Org Name:D-LIFE HEAL7#CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:FATUNBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-693-0505
Mailing Address - Street 1:2027 NORTH MASON ROAD
Mailing Address - Street 2:STE 303
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3778
Mailing Address - Country:US
Mailing Address - Phone:281-693-0505
Mailing Address - Fax:281-693-0509
Practice Address - Street 1:2027 NORTH MASON ROAD
Practice Address - Street 2:STE 303
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3778
Practice Address - Country:US
Practice Address - Phone:281-693-0505
Practice Address - Fax:281-693-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216404801Medicaid
TX216404802Medicaid