Provider Demographics
NPI:1568433761
Name:L.I.F.E. HOME CARE, INC
Entity Type:Organization
Organization Name:L.I.F.E. HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O./OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-683-4676
Mailing Address - Street 1:PO BOX 1558
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-1558
Mailing Address - Country:US
Mailing Address - Phone:417-683-4676
Mailing Address - Fax:471-683-6093
Practice Address - Street 1:113 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-1558
Practice Address - Country:US
Practice Address - Phone:417-683-4676
Practice Address - Fax:417-683-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health