Provider Demographics
NPI:1558663948
Name:LIFETOUCH LLC
Entity Type:Organization
Organization Name:LIFETOUCH LLC
Other - Org Name:LIFETOUCH HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:801-683-9541
Mailing Address - Street 1:1913 BONNEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4210
Mailing Address - Country:US
Mailing Address - Phone:801-683-9541
Mailing Address - Fax:801-292-4508
Practice Address - Street 1:1913 BONNEVIEW DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4210
Practice Address - Country:US
Practice Address - Phone:801-683-9541
Practice Address - Fax:801-292-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2011-HHA-99082251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
467320OtherCMS CERTIFICATION NUMBER