Provider Demographics
NPI:1205394707
Name:LIFEGUARD HOME CARE AGENCY INC.
Entity Type:Organization
Organization Name:LIFEGUARD HOME CARE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHERIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRITO PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:215-669-1577
Mailing Address - Street 1:4012 M ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-5326
Mailing Address - Country:US
Mailing Address - Phone:215-669-1577
Mailing Address - Fax:267-394-7519
Practice Address - Street 1:5341 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1217
Practice Address - Country:US
Practice Address - Phone:215-669-1577
Practice Address - Fax:267-394-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care