Provider Demographics
NPI:1104361872
Name:HEALING LIFE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:HEALING LIFE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-429-2379
Mailing Address - Street 1:26 PERCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-4516
Mailing Address - Country:US
Mailing Address - Phone:540-429-2379
Mailing Address - Fax:
Practice Address - Street 1:26 PERCHWOOD DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-4516
Practice Address - Country:US
Practice Address - Phone:540-429-2379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-171561251E00000X
VAMC1600186PS343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)