Provider Demographics
NPI:1164013207
Name:LIFE GLOW CARE
Entity Type:Organization
Organization Name:LIFE GLOW CARE
Other - Org Name:RIGHT AT HOME SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOARD OF DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-985-3600
Mailing Address - Street 1:200 E CAMPUS VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4678
Mailing Address - Country:US
Mailing Address - Phone:614-985-3600
Mailing Address - Fax:
Practice Address - Street 1:4510 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-4063
Practice Address - Country:US
Practice Address - Phone:380-213-0610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNOT REQUIRED