Provider Demographics
NPI:1083104806
Name:LIFE CHANGING ASSISTANCE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LIFE CHANGING ASSISTANCE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TATYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-715-2358
Mailing Address - Street 1:5025 DOOLITTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-3494
Mailing Address - Country:US
Mailing Address - Phone:832-715-2358
Mailing Address - Fax:
Practice Address - Street 1:5025 DOOLITTLE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033
Practice Address - Country:US
Practice Address - Phone:832-715-2358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1801320064OtherSOLE PROPRIETOR