Provider Demographics
NPI:1679088702
Name:LUCKY'S HOME CARE, LLC
Entity Type:Organization
Organization Name:LUCKY'S HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-378-2882
Mailing Address - Street 1:524 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-3728
Mailing Address - Country:US
Mailing Address - Phone:724-378-2882
Mailing Address - Fax:724-378-9809
Practice Address - Street 1:524 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-3728
Practice Address - Country:US
Practice Address - Phone:724-378-2882
Practice Address - Fax:724-378-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103000043-0001OtherPROVIDER NUMBER
PA25813601OtherPROVIDER LICENSE NUMBER