Provider Demographics
NPI:1205041845
Name:LIFE AT HOME LLC
Entity Type:Organization
Organization Name:LIFE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,RN
Authorized Official - Phone:337-463-3595
Mailing Address - Street 1:736 NORTH PINE STREET
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634
Mailing Address - Country:US
Mailing Address - Phone:337-463-3595
Mailing Address - Fax:337-463-3919
Practice Address - Street 1:736 NORTH PINE STREET
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634
Practice Address - Country:US
Practice Address - Phone:337-463-3595
Practice Address - Fax:337-463-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12352253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1179299Medicaid