Provider Demographics
NPI:1235368549
Name:A LIFE AT HOME LLC.
Entity Type:Organization
Organization Name:A LIFE AT HOME LLC.
Other - Org Name:COMFORT KEEPERS #756
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:BEAMGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-504-4974
Mailing Address - Street 1:4115 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1641
Mailing Address - Country:US
Mailing Address - Phone:248-504-4974
Mailing Address - Fax:248-419-5105
Practice Address - Street 1:4115 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:ORCHARD LAKE
Practice Address - State:MI
Practice Address - Zip Code:48323-1641
Practice Address - Country:US
Practice Address - Phone:248-504-4974
Practice Address - Fax:248-419-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINA - NON MEDICAL253Z00000X, 385H00000X
MIB526149847888347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care