Provider Demographics
NPI:1114117090
Name:LIFE DME LLC
Entity Type:Organization
Organization Name:LIFE DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FERASS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-795-1296
Mailing Address - Street 1:8896 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7153
Mailing Address - Country:US
Mailing Address - Phone:219-795-1296
Mailing Address - Fax:219-795-1349
Practice Address - Street 1:8896 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7153
Practice Address - Country:US
Practice Address - Phone:219-795-1296
Practice Address - Fax:219-795-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000307A332BX2000X
IL203001411332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200877790AMedicaid
IN000000536977OtherANTHEM PIN
IL203001411OtherIL HME PROVIDER
IN200877790AMedicaid