Provider Demographics
NPI:1043802028
Name:LIFE BUILDERS HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:LIFE BUILDERS HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAVONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-670-0311
Mailing Address - Street 1:6111 HARRISON ST STE 207
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2971
Mailing Address - Country:US
Mailing Address - Phone:219-670-0311
Mailing Address - Fax:
Practice Address - Street 1:6111 HARRISON ST STE 207
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2971
Practice Address - Country:US
Practice Address - Phone:219-670-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care