Provider Demographics
NPI:1033392865
Name:PURE LIFE HOME HEALTH CARE CORP
Entity Type:Organization
Organization Name:PURE LIFE HOME HEALTH CARE CORP
Other - Org Name:PURE LIFE HOME HEALTH CARE CORP.
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEKWUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-843-9468
Mailing Address - Street 1:3918 NACO PERRIN BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2518
Mailing Address - Country:US
Mailing Address - Phone:210-843-7265
Mailing Address - Fax:210-626-8087
Practice Address - Street 1:3918 NACO PERRIN BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2518
Practice Address - Country:US
Practice Address - Phone:210-843-7265
Practice Address - Fax:210-626-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-15
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011992251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
747336Medicare Oscar/Certification