Provider Demographics
NPI:1346890548
Name:LIFE HOME CARE INC
Entity Type:Organization
Organization Name:LIFE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YEONG
Authorized Official - Middle Name:SOON
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-750-0024
Mailing Address - Street 1:4601 PINECREST OFFICE PARK DR UNIT H
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1442
Mailing Address - Country:US
Mailing Address - Phone:703-750-0024
Mailing Address - Fax:703-750-0019
Practice Address - Street 1:4601 PINECREST OFFICE PARK DR UNIT H
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1442
Practice Address - Country:US
Practice Address - Phone:703-750-0024
Practice Address - Fax:703-750-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-202176OtherHOME CARE LICENSE