Provider Demographics
NPI:1609167048
Name:LIFESTAGES HEALTH AND HOME CARE, LLC
Entity Type:Organization
Organization Name:LIFESTAGES HEALTH AND HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERSON-MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PA-C
Authorized Official - Phone:832-722-7287
Mailing Address - Street 1:3226 OAK PARK LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3226 OAK PARK LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6604
Practice Address - Country:US
Practice Address - Phone:832-722-7287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care