Provider Demographics
NPI:1467142315
Name:LIFEHOUSE HEALTHCARE PLLC
Entity Type:Organization
Organization Name:LIFEHOUSE HEALTHCARE PLLC
Other - Org Name:LIFEHOUSE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:R
Authorized Official - Last Name:OROZCO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-243-9395
Mailing Address - Street 1:212 S 11TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4000
Mailing Address - Country:US
Mailing Address - Phone:208-667-3113
Mailing Address - Fax:208-668-8213
Practice Address - Street 1:212 S 11TH ST STE 1
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4000
Practice Address - Country:US
Practice Address - Phone:208-243-9395
Practice Address - Fax:951-466-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty