Provider Demographics
NPI:1669505798
Name:LIFE TIME PERSONAL CARE SERVICE, LLC
Entity Type:Organization
Organization Name:LIFE TIME PERSONAL CARE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DELAINE
Authorized Official - Last Name:THRASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-962-3101
Mailing Address - Street 1:1010 COMMON ST
Mailing Address - Street 2:SUITE 2660
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2401
Mailing Address - Country:US
Mailing Address - Phone:504-962-3101
Mailing Address - Fax:
Practice Address - Street 1:1010 COMMON ST
Practice Address - Street 2:SUITE 2660
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2401
Practice Address - Country:US
Practice Address - Phone:504-962-3101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11694251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1471275Medicaid
LA1165271Medicaid
LA1165271Medicaid