Provider Demographics
NPI:1407062490
Name:LIFE CARE HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:LIFE CARE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:EYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-272-5866
Mailing Address - Street 1:445 DOUGLAS AVE STE 1005
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2516
Mailing Address - Country:US
Mailing Address - Phone:407-682-3240
Mailing Address - Fax:407-682-3763
Practice Address - Street 1:445 DOUGLAS AVE STE 1005
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2516
Practice Address - Country:US
Practice Address - Phone:407-682-3240
Practice Address - Fax:407-682-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20647096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20647096OtherHHA LICENSE NUMBER
FL10D0922849OtherCLIA WAIVER NUMBER
FL109026Medicare Oscar/Certification