Provider Demographics
NPI:1619747227
Name:KEY LIFE HOME CARE, LLC
Entity Type:Organization
Organization Name:KEY LIFE HOME CARE, LLC
Other - Org Name:KEY LIFE HOME CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-867-7709
Mailing Address - Street 1:13641 STEPNEY LN
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3412
Mailing Address - Country:US
Mailing Address - Phone:703-867-7709
Mailing Address - Fax:
Practice Address - Street 1:13641 STEPNEY LN
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3412
Practice Address - Country:US
Practice Address - Phone:703-867-7709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care