Provider Demographics
NPI:1083858062
Name:LIFECARE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:LIFECARE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOLADEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-539-6889
Mailing Address - Street 1:24404 VERMONT AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2313
Mailing Address - Country:US
Mailing Address - Phone:310-539-6889
Mailing Address - Fax:310-517-0171
Practice Address - Street 1:24404 VERMONT AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2313
Practice Address - Country:US
Practice Address - Phone:310-539-6889
Practice Address - Fax:310-517-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001351251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000285452OtherCITY OF LOS ANGELES
CA059313OtherNGS-MEDICARE