Provider Demographics
NPI:1164947503
Name:LIFETIME HOME CARE LLC
Entity Type:Organization
Organization Name:LIFETIME HOME CARE LLC
Other - Org Name:LIFETIME HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISKIJA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABRAMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-455-8687
Mailing Address - Street 1:11206 68TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2940
Mailing Address - Country:US
Mailing Address - Phone:917-455-8687
Mailing Address - Fax:
Practice Address - Street 1:11206 68TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2940
Practice Address - Country:US
Practice Address - Phone:917-455-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health