Provider Demographics
NPI:1477751568
Name:LIFEGATE HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:LIFEGATE HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:STEPHENNIE
Authorized Official - Last Name:CHUKWUKELU
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:469-554-5482
Mailing Address - Street 1:310 EAST 1-30 STE B105
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043
Mailing Address - Country:US
Mailing Address - Phone:469-554-5482
Mailing Address - Fax:972-772-4725
Practice Address - Street 1:310 EAST INTERSTATE 30 STE B105
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043
Practice Address - Country:US
Practice Address - Phone:469-554-5482
Practice Address - Fax:972-772-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008064251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
67-9279OtherMEDICARE
TX1635716-01Medicaid
TX679279Medicare Oscar/Certification