Provider Demographics
NPI:1376090068
Name:LIFETOUCH HEALTHCARE PROVIDERS LLC
Entity Type:Organization
Organization Name:LIFETOUCH HEALTHCARE PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NDUKA
Authorized Official - Middle Name:IKPO
Authorized Official - Last Name:EKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-457-1345
Mailing Address - Street 1:2826 HIGHWAY 154
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1865
Mailing Address - Country:US
Mailing Address - Phone:678-251-2228
Mailing Address - Fax:678-815-0984
Practice Address - Street 1:2826 HIGHWAY 154
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1865
Practice Address - Country:US
Practice Address - Phone:678-251-2228
Practice Address - Fax:678-815-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care