Provider Demographics
NPI:1417163403
Name:LIFE CARE HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:LIFE CARE HOME HEALTH SERVICES LLC
Other - Org Name:HEALTH AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-303-5500
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-0200
Mailing Address - Country:US
Mailing Address - Phone:706-303-5500
Mailing Address - Fax:706-854-7382
Practice Address - Street 1:3500 SW CORPORATE PKWY
Practice Address - Street 2:STE 120
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8156
Practice Address - Country:US
Practice Address - Phone:772-288-7386
Practice Address - Fax:772-288-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21585096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21585096OtherHHA LICENSE
FL1076OtherOCCUPATIONAL LICENSE
FL21585096OtherHHA LICENSE