Provider Demographics
NPI:1417270273
Name:LCH CAP SERVICES
Entity Type:Organization
Organization Name:LCH CAP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TANYEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-567-2895
Mailing Address - Street 1:4952 MCALPINE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8547
Mailing Address - Country:US
Mailing Address - Phone:704-567-2895
Mailing Address - Fax:
Practice Address - Street 1:4952 MCALPINE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8547
Practice Address - Country:US
Practice Address - Phone:704-567-2895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECHANGES HOMEHEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3418536251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418536Medicaid