Provider Demographics
NPI:1508283334
Name:PURE LIFE LLC
Entity Type:Organization
Organization Name:PURE LIFE LLC
Other - Org Name:GODS COUNTRY PRIMARY HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFIQ
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-426-2786
Mailing Address - Street 1:1705 19TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-2301
Mailing Address - Country:US
Mailing Address - Phone:830-426-2786
Mailing Address - Fax:830-426-4786
Practice Address - Street 1:1705 19TH ST STE A
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-2301
Practice Address - Country:US
Practice Address - Phone:830-426-2786
Practice Address - Fax:830-426-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016337251E00000X
251J00000X, 253Z00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016337OtherTX DEPARTMENT OF AGING AND DISABILITY PAS LICENSE
TX3747P1801XOtherADDITIONAL TAXONOMY CODE