Provider Demographics
NPI:1760192702
Name:GREATLIFE HOME CARE, LLC
Entity Type:Organization
Organization Name:GREATLIFE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASARAAT
Authorized Official - Middle Name:GOYOM
Authorized Official - Last Name:KOMJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-918-3551
Mailing Address - Street 1:7880 HARBACH BLVD
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-1240
Mailing Address - Country:US
Mailing Address - Phone:515-918-3551
Mailing Address - Fax:
Practice Address - Street 1:7880 HARBACH BLVD
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1240
Practice Address - Country:US
Practice Address - Phone:515-918-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No273Y00000XHospital UnitsRehabilitation Unit
No282E00000XHospitalsLong Term Care Hospital
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No347C00000XTransportation ServicesPrivate Vehicle