Provider Demographics
NPI:1689143042
Name:LIFE PARTNERS HOME CARE AGENCY, LLC
Entity Type:Organization
Organization Name:LIFE PARTNERS HOME CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAKENDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-215-7470
Mailing Address - Street 1:2879 KNIGHTWAY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2367
Mailing Address - Country:US
Mailing Address - Phone:901-215-7470
Mailing Address - Fax:
Practice Address - Street 1:2879 KNIGHTWAY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2367
Practice Address - Country:US
Practice Address - Phone:901-215-7470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ044631Medicaid