Provider Demographics
NPI:1033557905
Name:LIFETIME HOME CARE LLC
Entity Type:Organization
Organization Name:LIFETIME HOME CARE LLC
Other - Org Name:LIFETIME HOME CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EGLOU
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOKOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-771-1696
Mailing Address - Street 1:2749 DOUGLAS DR N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2401
Mailing Address - Country:US
Mailing Address - Phone:770-771-1696
Mailing Address - Fax:
Practice Address - Street 1:7373 VALLEY VIEW LN APT 1060
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5561
Practice Address - Country:US
Practice Address - Phone:770-771-1696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care