Provider Demographics
NPI:1407889579
Name:LIFECARE HEALTH SERVICES, LLC.
Entity Type:Organization
Organization Name:LIFECARE HEALTH SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHOLA
Authorized Official - Middle Name:OLUNGBENGA
Authorized Official - Last Name:ODUNTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BS
Authorized Official - Phone:281-494-2881
Mailing Address - Street 1:4434 BLUEBONNET DR
Mailing Address - Street 2:SUITE122
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2904
Mailing Address - Country:US
Mailing Address - Phone:281-494-2881
Mailing Address - Fax:281-494-2882
Practice Address - Street 1:4434 BLUEBONNET DR
Practice Address - Street 2:SUITE 122
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2904
Practice Address - Country:US
Practice Address - Phone:281-494-2881
Practice Address - Fax:281-494-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010549251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010549OtherHOME AND COMM SUPPORT SER
679601Medicare Oscar/Certification